Author: "Ana P. Ortiz" / Topic: humans - Searchworks@Jio Institute Digital Library Search Results

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107 results on '"Ana P. Ortiz"'

1. Pre-vaccination prevalence of anogenital and oral human papillomavirus in young HIV-infected men who have sex with men

Author: Kahn, Jessica A, Belzer, Marvin, Chi, Xiaofei, Lee, Jeannette, Gaur, Aditya H, Mayer, Kenneth, Martinez, Jaime, Futterman, Donna C, Stier, Elizabeth A, Paul, Mary E, Chiao, Elizabeth Y, Reirden, Daniel, Goldstone, Steven E, Martinez, Ana P Ortiz, Cachay, Edward R, Barroso, Luis F, Da Costa, Maria, Wilson, Craig M, Palefsky, Joel M, and Interventions, for the AIDS Malignancy Consortium and Adolescent Medicine Trials Network for HIV AIDS
Subjects: Biomedical and Clinical Sciences, Clinical Sciences, HIV/AIDS, Infectious Diseases, Prevention, Urologic Diseases, Immunization, Sexually Transmitted Infections, Cancer, HPV and/or Cervical Cancer Vaccines, Vaccine Related, Clinical Research, Infection, Good Health and Well Being, Adolescent, Adult, Anal Canal, Genitalia, Male, HIV Infections, Homosexuality, Male, Humans, Male, Mouth, Papillomaviridae, Papillomavirus Infections, Prevalence, Young Adult, Adolescents, Clinical trials, Men who have sex with men, Vaccine, Human papillomavirus, HIV, AIDS Malignancy Consortium and Adolescent Medicine Trials Network for HIV/AIDS Interventions, Medical microbiology, Oncology and carcinogenesis
Abstract: The aims of this study were to: 1) determine prevalence of anogenital and oral HPV, 2) determine concordance between HPV at anal, perianal, scrotal/penile, and oral sites; and 3) describe factors associated with anogenital HPV types targeted by the 9-valent vaccine. Data were collected from 2012 to 2015 among men who have sex with men 18-26 years of age enrolled in a vaccine trial (N = 145). Penile/scrotal, perianal, anal, and oral samples were tested for 61 HPV types. Logistic regression was used to identify factors associated with types in the 9-valent vaccine. Participants' mean age was 23.0 years, 55.2% were African-American, and 26.2% were Hispanic; 93% had anal, 40% penile, and 6% oral HPV. Among those with anogenital infection, 18% had HPV16. Concordance was low between anogenital and oral sites. Factors independently associated with a 9-valent vaccine-type HPV were: race (African-American vs. White, OR=2.67, 95% CI=1.11-6.42), current smoking (yes vs. no, OR=2.37, 95% CI=1.03-5.48), and number of recent receptive anal sex partners (2+ vs. 0, OR=3.47, 95% CI=1.16-10.4). Most MSM were not infected with HPV16 or HPV18, suggesting that they may still benefit from HPV vaccination, but anogenital HPV was very common, highlighting the importance of vaccinating men before sexual initiation. CLINICAL TRIAL NUMBER: NCT01209325.
Published: 2019

2. Age-Specific Prevalence of Anal and Cervical Human Papillomavirus Infection and High-Grade Lesions in 11 177 Women by Human Immunodeficiency Virus Status: A Collaborative Pooled Analysis of 26 Studies

Author: Feixue Wei, Ningshao Xia, Rebeca Ocampo, Marc T Goodman, Nancy A Hessol, Beatriz Grinsztejn, Ana P Ortiz, Fanghui Zhao, Erna M Kojic, Rupert Kaul, Isabelle Heard, Imran O Morhason-Bello, Anna-Barbara Moscicki, Alexandra de Pokomandy, Joel M Palefsky, Luana L S Rodrigues, Racheal S Dube Mandishora, Reshmie A Ramautarsing, Silvia Franceschi, Sheela V Godbole, Fernanda K Tso, Lynette J Menezes, Chunqing Lin, and Gary M Clifford
Subjects: Adult, HPV, Adolescent, Squamous Intraepithelial Lesions, Anal Canal, Uterine Cervical Neoplasms, HIV Infections, Cervix Uteri, Cervical Cancer, Medical and Health Sciences, Microbiology, Young Adult, cervix, Prevalence, Immunology and Allergy, Humans, 2.2 Factors relating to the physical environment, Aetiology, Papillomaviridae, Early Detection of Cancer, Cancer, Human papillomavirus 16, Prevention, Papillomavirus Infections, Age Factors, virus diseases, HIV, Human Papillomavirus Viruses, anus, Biological Sciences, Anus Neoplasms, female genital diseases and pregnancy complications, Infectious Diseases, Good Health and Well Being, Sexually Transmitted Infections, HIV/AIDS, Female, women, Infection
Abstract: Background Age-specific data on anal, and corresponding cervical, human papillomavirus (HPV) infection are needed to inform female anal cancer prevention. Methods We centrally reanalyzed individual-level data from 26 studies reporting HPV prevalence in paired anal and cervical samples by human immunodeficiency virus (HIV) status and age. For women with HIV (WWH) with anal high-grade squamous intraepithelial lesions or worse (HSIL+), we also investigated concurrent cervical cytopathology. Results In HIV-negative women, HPV16 prevalence decreased significantly with age, both at anus (4.3% at 15–24 years to 1.0% at ≥55 years; ptrend = 0.0026) and cervix (7.4% to 1.7%; ptrend < 0.0001). In WWH, HPV16 prevalence decreased with age at cervix (18.3% to 7.2%; ptrend = 0.0035) but not anus (11.5% to 13.9%; ptrend = 0.5412). Given anal HPV16 positivity, concurrent cervical HPV16 positivity also decreased with age, both in HIV-negative women (ptrend = 0.0005) and WWH (ptrend = 0.0166). Among 48 WWH with HPV16-positive anal HSIL+, 27 (56%) were cervical high-risk HPV-positive, including 8 with cervical HPV16, and 5 were cervical HSIL+. Conclusions Age-specific shifts in HPV16 prevalence from cervix to anus suggest that HPV infections in the anus persist longer, or occur later in life, than in the cervix, particularly in WWH. This is an important consideration when assessing the utility of cervical screening results to stratify anal cancer risk.
Published: 2023

3. Implementation of the human papillomavirus school-entry requirement in Puerto Rico: barriers and facilitators using the consolidated framework for implementation research

Author: Olga L Díaz-Miranda, Ana P. Ortiz, Roxana Soto-Abreu, Vivian Colón-López, Erick Suárez, Diana T. Medina-Laabes, and Pamela C. Hull
Subjects: Pharmacology, Medical education, Schools, Papillomavirus Infections, Puerto Rico, education, Immunology, virus diseases, School entry, Alphapapillomavirus, humanities, Political science, Humans, Immunology and Allergy, Papillomavirus Vaccines, Implementation research, Human papillomavirus, Child, Papillomaviridae, geographic locations, Research Paper
Abstract: Background: In 2018, Puerto Rico (PR) enacted a Human papillomavirus (HPV) vaccine school-entry requirement for students ages 11 to 12. Using the Consolidated Framework for Implementation Research (CFIR), we aimed to identify potential barriers and facilitators of this implementation.Methods: We conducted a total of 36 qualitative interviews with key informants who were stakeholders from different organizations (Department of Health, Schools, Healthcare Providers, and Community organizations in favor of the requirement) from July 2018 to January 2020. Three researchers performed the interview guide, data coding, and analysis according to the CFIR framework. We evaluated construct rating variability between the organizations to determine barriers and facilitators. Results: The strongest facilitators determined under the CFIR construct include the stakeholder's awareness of the parent's and student's needs to meet the HPV school-entry requirement. Other facilitators include initiatives for school-entry policies and the relative advantage of this requirement over different strategies. The strongest barriers included the cost for private providers to administer the HPV vaccine, the negative influence of social media about the vaccine, which affected parents' acceptance, and the lack of school nurses as available staff resources for the school entry requirement. Conclusions: Findings from this study can be used to improve implementation (adaptations/modifications) and inform other US states and countries in earlier stages of consideration of the adoption of similar immunization policies. Most barriers can be modifiable with the implementation of educational programs/training across schools, considering that they are the first line of response to parents of this school entry requirement.
Published: 2021

4. Sex and educational attainment differences in HPV knowledge and vaccination awareness among unvaccinated-sexually active adults in Puerto Rico

Author: Maira A. Castañeda-Avila, Carla J. Oramas Sepúlveda, Cynthia M. Pérez, Jeslie M. Ramos-Cartagena, Kimil Acosta Pagán, Josué Pérez-Santiago, Filipa Godoy-Vitorino, and Ana P. Ortiz
Subjects: Adult, Male, Pharmacology, Health Knowledge, Attitudes, Practice, Immunization Programs, Papillomavirus Infections, Puerto Rico, Vaccination, Immunology, Alphapapillomavirus, Cross-Sectional Studies, Humans, Immunology and Allergy, Female, Papillomavirus Vaccines, Papillomaviridae
Abstract: Human papillomavirus (HPV) knowledge and HPV vaccination uptake remain suboptimal. We assessed sex and educational attainment differences in HPV knowledge and vaccine awareness. Data from a cross-sectional study (2018-2021) in Puerto Rico among adults aged 21-49 was analyzed (
Published: 2022

5. Oral microbiota and periodontitis severity among Hispanic adults

Author: Ana P. Ortiz, Kimil T. Acosta-Pagán, Carla Oramas-Sepúlveda, Maira A. Castañeda-Avila, Brayan Vilanova-Cuevas, Jeslie M. Ramos-Cartagena, José A. Vivaldi, Josué Pérez-Santiago, Cynthia M. Pérez, and Filipa Godoy-Vitorino
Subjects: Microbiology (medical), Adult, Inflammation, Microbiota, Immunology, Hispanic or Latino, Middle Aged, Microbiology, Young Adult, Infectious Diseases, Cross-Sectional Studies, Humans, Dysbiosis, Periodontitis, Periodontal Diseases
Abstract: BackgroundPeriodontitis, one of the most common bacterial infections characterized by chronic inflammation, is also known to be a risk factor for chronic conditions, including cardiovascular disease and cancer. This inflammation is driven by an altered microbiota with an increase in pathogenic bacteria. We evaluated the association between oral microbiota and periodontitis severity in high-risk Hispanics.MethodThis cross-sectional study recruited 134 sexually active participants aged 21 to 49 years old from STI Clinics in Puerto Rico. A periodontal examination, saliva collection, and an interviewer-administered questionnaire were performed. Periodontal severity was categorized as: having no disease, mild, and moderate/severe and BOP and tooth loos was noted. Saliva samples were collected for genomic DNA extraction, downstream 16S rDNA amplification sequencing, and bioinformatics analyses.ResultsThe structure, composition, and diversity of bacterial communities differed significantly according to periodontal severity. The richness and overall diversity also differed between participants without periodontitis and participants with some level of periodontal disease. A higher abundance of Prevotella, Veillonella, or Treponema was attributed to periodontal disease and Aggregatibacter to severe bleeding on probing, while Neisseria was found in higher abundance in healthy participants, decreasing its levels with drinking, smoking, and oral sex practices.ConclusionsOur findings indicate that dysbiosis occurs as periodontal disease progresses, and both alcohol consumption and smoking habits pose risk factors for oral dysbiosis. These results are of public health and clinical impact, as several bacteria identified could serve in the future as biomarkers for periodontitis and oral cancer risk.
Published: 2022

6. Strengthening Resilience and Adaptive Capacity to Disasters in Cancer Control Plans: Lessons Learned from Puerto Rico

Author: Jessica Cabrera-Marquez, William A. Calo, Guillermo Tortolero-Luna, Sandra I García-Camacho, Pablo Méndez-Lázaro, Ana Mercado-Casillas, and Ana P. Ortiz
Subjects: 0301 basic medicine, Economic growth, Epidemiology, Natural Disasters, 03 medical and health sciences, Extreme weather, 0302 clinical medicine, Cancer control, Risk Factors, Neoplasms, Health care, medicine, Humans, Resilience (network), Adaptive capacity, Jurisdiction, business.industry, Puerto Rico, Cancer, medicine.disease, United States, 030104 developmental biology, Emergency response, Oncology, 030220 oncology & carcinogenesis, business
Abstract: Patients with cancer are among the most vulnerable populations in the aftermath of a disaster. They are at higher risk of medical complications and death due to the collapse of or disruptions in the health care system, the community infrastructure, and the complexity of cancer care. The United Nations' Sendai Framework for Disaster Reduction states that people with life-threatening and chronic diseases should be considered in disaster plans to manage their risks. With extreme weather or disasters becoming more intense and frequent and with the high burden of cancer in the United States and its territories, it is important to develop region-specific plans to mitigate the impact of these events on the cancer patient population. After Hurricanes Irma and Maria hit Puerto Rico and the U.S. Virgin Islands in 2017, the need to develop and implement such plans for patients with cancer was evident. We describe ongoing efforts and opportunities for disseminating and implementing emergency response plans to maintain adequate cancer care for patients during and after disasters. While plans for patients with cancer should be housed within the emergency support function infrastructure of each jurisdiction, the Centers for Disease Control and Prevention's Comprehensive Cancer Control Plans provide excellent community-centered mechanisms to support these efforts.
Published: 2020

7. Assessment of Anal Cancer Screening Tools in Detecting High-Grade Anal Squamous Intraepithelial Lesions in Women

Author: Maribel Tirado-Gomez, Claudia P Amaya-Ardilla, Ana P. Ortiz, Jeslie M Ramos-Cartagena, Cynthia M. Pérez, and Humberto M. Guiot
Subjects: Adult, medicine.medical_specialty, Adolescent, Genotyping Techniques, Cross-sectional study, Biopsy, Squamous Intraepithelial Lesions, Cytological Techniques, Sensitivity and Specificity, Gastroenterology, Article, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Cytology, Internal medicine, Humans, Medicine, Anal cancer, Young adult, Papillomaviridae, Early Detection of Cancer, Aged, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, Puerto Rico, Obstetrics and Gynecology, Anoscopy, Endoscopy, Histology, General Medicine, Middle Aged, Anus Neoplasms, medicine.disease, Cross-Sectional Studies, 030220 oncology & carcinogenesis, Predictive value of tests, Female, business
Abstract: OBJECTIVE The aim of the study was to evaluate the validity of anal cytology against high-resolution anoscopy in the detection of anal high-grade squamous intraepithelial lesions (HSILs) among women in a clinical setting in Puerto Rico, alone and in combination with high-risk human papillomavirus (HR-HPV) typing. MATERIALS AND METHODS A cross-sectional study was done among 128 eligible women who attended the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Center between 2014 and 2019. Kappa (κ) coefficient, sensitivity, specificity, positive predictive value, and negative predictive value were calculated using high-resolution anoscopy with biopsy as the criterion standard test. Poisson regression was used to estimate the adjusted prevalence ratio of anal HR-HPV infection. RESULTS Overall, 71.1% of women were HIV infected and 78.9% had anal HR-HPV infection. Squamous intraepithelial lesions were detected with anal cytology and histology in 70.3% and 81.3% of women, respectively. The κ statistic between the tests (cytology and histology) was 0.32 (p < .05). Measured against the results from histology, the sensitivity of anal cytology alone to detect HSIL was 85.4% (95% CI = 72.2%-93.9%), whereas specificity was 38.8% (95% CI = 28.1%-50.3%). Although the sensitivity of the 2 tests combined (anal cytology and HR-HPV typing) to detect histologically confirmed HSIL increased (100.0%, 95% CI = 92.6%-100.0%), the specificity decreased (16.3%, 95% CI = 9.0%-26.2%). Meanwhile, women with HSIL had a higher prevalence of anal HR-HPV infection than those with no SIL/LSIL (prevalence ratio = 6.23, 95% CI = 1.50-25.83). CONCLUSIONS Anal cytology in combination with HR-HPV typing for the screening of anal intraepithelial neoplasia improved the detection of HSIL in women.
Published: 2020

8. Association of Body Mass Index With Adherence to Cervical Cancer Screening Recommendations in Hispanic Women

Author: Daisy González-Barrios, Cynthia M. Pérez, Jeslie M Ramos-Cartagena, and Ana P. Ortiz
Subjects: Adult, medicine.medical_specialty, Population, Uterine Cervical Neoplasms, Overweight, Body Mass Index, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, medicine, Humans, Obesity, Young adult, education, Early Detection of Cancer, Cervical cancer, education.field_of_study, 030219 obstetrics & reproductive medicine, Class III obesity, Obstetrics, business.industry, Puerto Rico, Obstetrics and Gynecology, Hispanic or Latino, General Medicine, Odds ratio, Middle Aged, medicine.disease, United States, 030220 oncology & carcinogenesis, Patient Compliance, Female, medicine.symptom, Underweight, business, Body mass index, Facilities and Services Utilization
Abstract: Objective Obese women have higher cervical cancer incidence and mortality than their counterparts, possibly related to nonadherence to screening recommendations. We assessed the association of body mass index with adherence to cervical cancer screening recommendations in Hispanic women living in Puerto Rico, a minority population with the highest incidence of cervical cancer in the United States. Materials and methods We included 536 Hispanic women aged 21 to 64 years enrolled in a population-based study of human papillomavirus (HPV) infection. Demographic and clinical characteristics and risky behaviors were collected using structured interviews. Weight and height were measured to classify body mass index as underweight, normal, overweight, and obesity (class I, class II, class III). Adherence to cervical cancer screening recommendations was self-reported. Logistic regression models were fit to estimate the odds ratio with 95% CI after adjusting for covariates. Results Nearly one third (29.7%) of women were overweight and 43.5% were obese (class I: 22.6%, class II: 11.0%, class III: 9.9%). Overall adherence to cervical cancer screening within the past 3 years was 78.5%, being lowest among women with class III obesity (60.4%). After multivariable adjustment, only women with class III obesity had significantly higher odds (odds ratio = 2.5, 95% CI: 1.2-5.1) of reporting nonadherence to cervical cancer screening compared with normal weight women. Conclusions Adherence to cervical cancer screening in this population was below the Healthy People 2020 target of 93%, especially for women with morbid obesity. These findings highlight the importance of adequate interventions to decrease cervical cancer screening disparities in these women.
Published: 2020

9. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. Tulloch-Reid, Seppo Koskinen, James E. Bennett, Marcela González-Gross, Virginija Dulskiene, Idris Guessous, Assembekov Batyrbek, Kamarul Imran Musa, Jeannette Lee, Josep Redon, Bihungum Bista, Luisa M Macieira, Johan Sundström, Andres Metspalu, Lariane M Ono, Flora A. Ukoli, Salar Rahimikazerooni, Andrea Gualtieri, Trevor S. Ferguson, Félicité Tchibindat, Eliza Cinteza, Ha Tp Do, Tajana Zeljkovic Vrkic, Tuyen D Le, Alison J. Hayes, Abdul Basit, Chandini Nekkantti, Teresa Norat, Eunice Ugel, Gulmira Aitmurzaeva, Mariachiara Di Cesare, Abdul Hamid Zargar, Vincenzo Solfrizzi, Garry L. Jennings, Aline Meirhaeghe, Kaare Christensen, Päivi Mäki, Xu Lin, Ali Esmaeili, Joanna Baran, Aneta Grajda, Renata Cifkova, Alexandre C. Pereira, Martin Bobak, Iuliia A Rusakova, Keiu Nelis, Damian K Francis, Guansheng Ma, Axel C. Carlsson, Alejandro Diaz, Alireza Ansari-Moghaddam, N Capkova, Zumin Shi, Maria Turley, Imelda A. Agdeppa, Helena I. S. Nogueira, Marcia Scazufca, Katharina Maruszczak, Natascia Rinaldo, Paulo A. Lotufo, Nuno Lunet, Thor Aspelund, Caroline H.D. Fall, Antonio Cabrera de León, Ahmad Faudzi Yusoff, Holger Theobald, Beatriz D'Agord Schaan, Pedro Marques-Vidal, William A. Neal, Mihai Gafencu, Tandi E. Matsha, Ana B. Crujeiras, Ahmad Reza Dorosty, Alain Morejon, Weili Yan, Dominique Hange, Bekbolat Zholdin, Frédéric Gottrand, Jorge Mota, Jana Námešná, Stevo Popovic, Louise Eriksen, Line Lund Kårhus, Cihangir Erem, Juergen Breckenkamp, Mathilde Kersting, Yi Song, Martin McKee, Aleksandra Gomula, Rafaela Rosário, Enzo Manzato, S. Goya Wannamethee, Sounnia Mediene Benchekor, Azim Nejatizadeh, Krishna Kumar Aryal, Juan P. González-Rivas, Vedrana Sember, Stephen T. McGarvey, Jukka T. Salonen, Patrick Pasquet, Patricia Varona-Pérez, Amelia C. Crampin, Ramin Heshmat, Violeta Iotova, Juvenal Soares Dias-da-Costa, Oye Gureje, Aletta E. Schutte, João Luiz Bastos, Anelise Reis Gaya, Konrad Jamrozik, Dalia Luksiene, Amina Barkat, Maria Paula Santos, José Camolas, Azli Baharudin, Diego Vanuzzo, Doris Stöckl, Rosalynn Siantar, Jouko Saramies, Albertino Damasceno, Davood Khalili, Simona Bo, Martina Müller-Nurasyid, Dominique Cottel, Markku Peltonen, Fikru Tullu, Ana Isabel Rito, Angélica Ochoa-Avilés, Annette J. Dobson, Christopher T. Cowell, Charumathi Sabanayagam, Rildo de Souza Wanderley Júnior, Oanh T. H. Trinh, Farahnaz Joukar, Mostafa K. Mohamed, Mostafa Qorbani, Jeongseon Kim, Helmut Schröder, Machi Suka, Natasja M. van Schoor, Jussi Kauhanen, Teresa Haugsgjerd, Goodarz Danaei, M. Fernanda Lima-Costa, Yong Tao, Elisabetta L. Romeo, Grazyna Jasienska, Victor Guillermo Sequera, Kazem Mohammad, Yanina Zócalo, Fernanda Cunha Soares, Jianfeng Wu, Mohammad Esmaeel Motlagh, María Elena Díaz-Sánchez, Monika Zuziak, Eldridge Ferrer, Anette Varbo, Leila Beltrami Moreira, Jeremy M. Jacobs, Kenneth James, Elena Sacchini, Pascal Bovet, Mahboubeh Parsaeian, Tania Lopez, Ya Xing Wang, Wojciech Drygas, Jody C Miller, Svetlana A. Shalnova, Maria Elisa Zapata, Chung T Nguyen, Nimmathota Arlappa, Edwige Landais, Thorkild I. A. Sørensen, Jeannette Klimont, Amirabbas Momenan, Erik J. Timmermans, Mari-Liis Tammesoo, Jost B. Jonas, Stefania Toselli, Maria Teresa Anselmo Olinto, Bahman Cheraghian, Kouamelan Doua, Esteban Carmuega, Marjeta Mišigoj-Duraković, Bo Werner, M. Arfan Ikram, Breige A. McNulty, Christa Meisinger, Clara Homs, Namuna Shrestha, Alina Kerimkulova, Youcef Laid, Claes Ohlsson, Alicia Matijasevich, Alison J Price, Ala'a Alkerwi, Kristine H. Allin, Lorenza Pilotto, Mohannad Al Nsour, Ingunn Holden Bergh, Marianna Noale, Heba Fouad, Vilnis Dzerve, Novie O. Younger-Coleman, Peter Willeit, Andrea R. V. R. Horimoto, Freda Pitakaka, Habiba Ben Romdhane, Savvas C. Savva, Rajeev Gupta, Jennifer Servais, Cristina Padez, Sarah P. Garnett, Maria del Cristo Rodriguez-Perez, Michala Lustigová, Tien Yin Wong, Rosa Haghshenas, Jonathan Giovannelli, Christina Howitt, Marleen E. Hendriks, Fadia AlBuhairan, Huashuai Chen, Gretchen A Stevens, Luís B. Sardinha, David Goltzman, Jenny M. Kindblom, Karina Mary de Paiva, Yousef Khader, Eric Monterrubio-Flores, Rajendra Pradeepa, Yi-Ting Lin, Martin Neovius, Juan Francisco Miquel, Ellis Owusu-Dabo, Anil Poudyal, Marzieh Katibeh, Tanja Stocks, Veronica Mocanu, Ulla Roggenbuck, Robespierre Ribeiro, Gabriele Eiben, Mary Simon, Christine Cameron, Hamid Hakimi, Kamel Ajlouni, Jakub Stokwiszewski, Iulia Jurca Simina, Pietro Amedeo Modesti, Frederick C. W. Wu, Peter Kristensen, Charles Mondo, Felix Gutzwiller, Mariana Sbaraini, Martijn Huisman, Betina H. Thuesen, Queenie Chan, Antonisamy Belavendra, Artur Mazur, Ulf Ekelund, Laura A. Rodríguez-Villamizar, Marcos André Moura-dos-Santos, Jean Ferrières, Farhad Zamani, Shina Avi, Yves Kameli, Luis Paulo Gomes Mascarenhas, Aluísio J D Barros, Thomas Meinertz Dantoft, Hossein Poustchi, Farid Najafi, Giovanni de Gaetano, Azaliia M Tuliakova, Vera Lanska, Tint Swe Latt, Matthias Bopp, Abbas Rezaianzadeh, Rod Jackson, Johan Van der Heyden, Reecha Sofat, Koen Van Herck, Allan G. Hill, Con Burns, Emanuela Pettenuzzo, Ming-Dong Wang, Stela McLachlan, Ulrike Gehring, Ranko Stevanovic, Nagalla Balakrishna, Lekhraj Rampal, Marjolijn C. E. Bragt, Saeid Eslami, Napoleón Pérez-Farinós, G. K. Mini, Viktoria Anna Kovacs, Rosemarie Martin, Nahla Hwalla, Wei Zheng, Hoang Van Minh, Edward D Janus, Laetitia Huiart, Farhad Pourfarzi, Sudha Ramachandra Rao, Fred Paccaud, Marcia Makdisse, Aye Aye Sein, Enrique Gutiérrez-González, Yang Yang, Anneke Blokstra, Henrike Galenkamp, Jaume Marrugat, Nazan Yardim, Wan Nazaimoon Wan Mohamud, Jesús Ibarluzea, Julio Zuñiga Cisneros, Laura Lauria, Argyro Karakosta, Dragana P Jovic, Jun Hata, Elio Riboli, Piotr Bandosz, Xun Tang, Parvina Mukhtorova, Jean Dallongeville, Jean-Bernard Ruidavets, Anne Tjønneland, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Aleksandra Piwońska, Dusan Grafnetter, Mette Rasmussen, Daniel Weghuber, Sherali Rakhmatulloev, Martine Vrijheid, Johann Willeit, Motahareh Kheradmand, Małgorzata Mossakowska, Lechaba Tshepo, Dongfeng Gu, Hyeon Chang Kim, Vilmundur Gudnason, Maria Forsner, Peter Bjerregaard, Leon A. Simons, Rachael McLean, Japhet Killewo, Ramón Suárez-Medina, Y Nikitin, Eng Joo Tan, Jean Claude Mbanya, Aroor Bhagyalaxmi, Renata Kuciene, Kairat Davletov, Jose Eugenio Lozano, Afshin Ostovar, Niloofar Peykari, Guy De Backer, Soheir H Ahmed, Nicholas J. Wareham, Sai Yin Ho, Constanta Huidumac Petrescu, Maria Hassapidou, Iris Pigeot, Myriam Galfo, Susana Cararo Confortin, Blanca Sandra Ruiz-Betancourt, W. M. Monique Verschuren, Catterina Ferreccio, Fabio Galvano, Leila Houti, Daniel Bia, Annika Rosengren, Marcin Rutkowski, Biruta Velika, Joana Araújo, Fernando Rigo, Angela Spinelli, Scott B. McLean, Shirin Djalalinia, Marie Kunešová, Boban Mugoša, Sania Nishtar, Mangesh S. Pednekar, Shahla AlDhukair, Helle-Mai Loit, Antonis Zampelas, Altan Onat, Maciej Banach, Shohreh Naderimagham, Hajer Aounallah-Skhiri, Maja Bæksgaard Jørgensen, Yin Guo, Ewelina Czenczek-Lewandowska, Parasmani Dasgupta, Elvis Oa Wambiya, Inge Huybrechts, Raimund Erbel, Jari Jokelainen, Ana P. Ortiz, Stefan Kiechl, Emmanuel Cohen, Caleb Ochimana, Shynar Abdrakhmanova, Laura Censi, Iqbal Bata, Geetha R Menon, Snehalatha Chamukuttan, Pedro Plans-Rubio, Domenico Palli, Ana Azevedo, Slawomir Koziel, Benoît Salanave, Parinaz Mehdipour, Shu Ti Chiou, Lela Sturua, Lubica Ticha, Felipe Vogt Cureau, Jin Soo Moon, Ming-Hui Zhao, Urho M. Kujala, Nathalie Michels, Ertugrul Celikcan, Jaakko Tuomilehto, Judith Benedics, Tobias F. Rinke de Wit, Agnès Le Port, Reza Homayounfar, Andrea Rodriguez-Martinez, Tai Hing Lam, Yn-Tz Sung, Jürgen König, Kodavanti Mallikharjuna Rao, Hazzaa M. Al-Hazzaa, Karen Morgan, Bogdan Wojtyniak, Cynthia M. Pérez, Ilse Khouw, Manoli Garcia-de-la-Hera, Dong Wook Shin, Genc Burazeri, Ausra Petrauskiene, Charles Sossa Jérome, Kenisha Russell Jonsson, José Boggia, Daniela Galeone, Alice Bonilla-Vargas, Han Cg Kemper, Rahman Shiri, Stefaan Demarest, Else Karin Grøholt, San-Lin You, Adelheid Weber, Juha Auvinen, Aida Pilav, Sibel Gogen, Suzanne N Morin, Wan Mohamad Wan Bebakar, Viviane Cunha Cardoso, Kavumpurathu Raman Thankappan, Hana Zamrazilová, Frank Claessens, Karien Stronks, Helen Gonçalves, Tahir Aris, Luis Revilla, Sérgio Viana Peixoto, Zhamilya Battakova, Jing Liu, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Priscilla Duboz, Sandjaja, Tiina Laatikainen, Rafel Ramos, Sareh Eghtesad, Judith Simons, Orn Olafsson, E. Shyong Tai, Louise A. Baur, Nihal Thomas, Aung Soe Htet, Bente Sparboe-Nilsen, Paul Elliott, Soon-Woo Park, Angel R. Gonzalez, Ying-Wei Wang, Rob M. van Dam, Ryutaro Ohtsuka, Ludmila Sevcikova, Suhaila Abdul Ghaffar, Lynell V Maniego, Fariborz Mansour-Ghanaei, Maria Dorobantu, Giovanni Viegi, Xiaoguang Yang, Honor Bixby, Prakash C. Gupta, Ofra Kalter-Leibovici, Eugene Sobngwi, Ričardas Radišauskas, Jurate Medzioniene, Roy A Wong-McClure, Kim F. Michaelsen, Antonia Trichopoulou, Tania Tello, Francesco Branca, Johanna Gunnlaugsdottir, Els Clays, Wei-Yen Lim, Suzanne C. Ho, Toomas Veidebaum, Rebecca Goldsmith, Margot González-León, Matthias Nauck, Alibek Mereke, Marta Buoncristiano, Jakob Tarp, Rosalba Rojas-Martínez, Maya Tanrygulyyeva, Reza Malekzadeh, Abdonas Tamosiunas, Dimitrios Poulimeneas, Pedro Ordunez, Isabelle Herter-Aeberli, Khanh Le Nguyen Bao, Anne Juolevi, Vassilis Zafiropulos, Emanuela Gualdi-Russo, Jordi Sunyer, Manu Raj, Chaoqiang Jiang, Sofia Malyutina, Efthymios Kapantais, Maria Lazo-Porras, Maung Maung Than Htike, Michael Hobbs, Ranjit Mohan Anjana, Merike Liivak, Johan G. Eriksson, Margarita Samoutian, Andreia N. Pizarro, Mohammed Rasoul Tarawneh, Jean Woo, Kaspar Staub, Maria Teresa Menzano, Mojtaba Farjam, Adroaldo Cesar Araujo Gaya, Mohammad El-khateeb, Zulfiqar A Bhutta, Mukharram M. Bikbov, Hsien-Ho Lin, Oscar Noboa, Thomas Waldhör, Garry Brian, Simona Costanzo, Frank Tanser, Nor Azwany Yaacob, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ioannis Pagkalos, Ivan Pećin, Carlo M. Barbagallo, Abla M. Sibai, Yuna He, Matsuda Fumihiko, Bharathi Viswanathan, Ali Reza Safarpour, Wei Cheng Lo, Abdullatif Husseini, Jiang He, Liv Elin Torheim, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Davide Noto, Panayiotis K. Yiallouros, Kelias P. Msyamboza, William R. Tebar, Yingfeng Zheng, Eha Nurk, Bhawesh Koirala, Ana Jelakovic, Suhad Bahijri, Freja B Kampmann, Qi Sheng You, Marika Ferrari, María-Elena González-Villalpando, Aline Wagner, Olfa Saidi, Anwar Batieha, Eduardo Capuano, Coimbatore Subramaniam Shanthirani, Dong Wook Kim, Albina A Fakhretdinova, Tom Wilsgaard, Maria Avdicova, Moesijanti Soekatri, Chiara Donfrancesco, Salim Mohanna, Paola Russo, Uruwan Yamborisut, Rafael dos Santos Henrique, Martin Nankap, Allan Linneberg, Khairil Si-Ramlee, Kirsten Mehlig, Christina Mavrogianni, Raluca Pop, Lèlita Santos, Graziella Bruno, Valentina Peterkova, Iná S. Santos, Georg Lappas, Alberto Palloni, Malay K. Mridha, Andrzej Pajak, Marta García-Solano, Stefaan De Henauw, Daniel Ferrante, Rute Santos, Anders Grøntved, Lucjan Szponar, Mihaela Vladulescu, Chien-An Sun, Jan A. Staessen, Paula Duarte de Oliveira, Norazizah Ibrahim Wong, Maria Nordendahl, Elaine M. Dennison, Jeonghee Lee, Diego Salmerón, Ida Maria Schmidt, Gao Pei, Noushin Mohammadifard, Igor Spiroski, Fernando Rodríguez-Artalejo, Xu Ma, Elin Pettersen Sørgjerd, Valéria Regecová, Cláudia S. Minderico, Johanna A. Otero, Jamila Abubakar Garba, Vesselka Duleva, Rui Ornelas, Ilpo Huhtaniemi, Cesar G. Victora, Lijuan Liu, Rody G. Sy, Mahmood Moosazadeh, Ali Ahmadi, Antonio Pedro Graça, Natalia Nowak-Szczepanska, Miao Li Chee, Michael Sjöström, Charles Agyemang, Shiqi Zhen, Xiu-Hua Guo, Pawel Kurjata, Jardena J. Puder, Mehrdad Azmin, Neil Murphy, Kaosar Afsana, Alireza Sadjadi, Johanna M. Geleijnse, Prashant Mathur, Elysée Claude Bika Lele, Raphael Mendes Ritti-Dias, Yannis Manios, Majid Shirani, Rosemary B. Duda, Liis Nelis, Jurate Klumbiene, Zhengming Chen, Wichai Aekplakorn, Alun Evans, Andrzej Wiecek, Lars Lind, Denise Eldemire-Shearer, Bernardo L. Horta, Macia Enguerran, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Kumiko Ohara, Ursula Kiechl-Kohlendorfer, Hermann Brenner, Przemyslaw Slusarczyk, Espen Bjertness, Jutta Stieber, Augusto Di Castelnuovo, Joel G. R. Roy, Aryeh D. Stein, Ruth Frikke-Schmidt, Vera Musil, Amaneh Shayanrad, Marcel Goldberg, Ramon O. Jimenez, Mohammad Reza Fattahi, Jolanda Hyska, Amir Houshang Mehrparvar, Elin Kolle, Mohamed Bamoshmoosh, Michelle Holdsworth, Felipe F. Casanueva, Børge G. Nordestgaard, Niels Wedderkopp, Eva Corpeleijn, Elias F. Gudmundsson, Antonio Mistretta, Daniel Lemogoum, Larissa Pruner Marques, Slavica Sović, Olli T. Raitakari, Marco Aurélio Peres, Alexandra Cucu, Gregorio Varela-Moreiras, Janine Clarke, Andrea Gazzinelli, Mieczysław Litwin, Sara Schramm, Xenophon Theodoridis, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Dimitrios Papandreou, Peter T. Katzmarzyk, Benjamin Acosta-Cazares, Ben Schöttker, Prabhdeep Kaur, Norlaila Mustafa, Shariq Rashid Masoodi, Sadaf G. 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Duante, Sheikh Mohammed Shariful Islam, Quang Ngoc La, Ricky Eddie, Petra Rust, Daniela Rodrigues, Dirk De Bacquer, Karen Sparrenberger, Agneta Sjöberg, Thet Thet Mu, Katarzyna Dereń, Cora L. Craig, Jorge Motta, Janina Petkeviciene, Boyd Swinburn, Paibul Suriyawongpaisal, Visnja Djordjic, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Daan Kromhout, Marius B. Bjertness, Stefano Marventano, Juel Jarani, Alireza Khosravi, Eva Martos, David De Ridder, Lizzy M. Brewster, Nico Dragano, Liam Smeeth, Kenji Shibuya, Emma Ruiz Moreno, Hashem Jaddou, Grzegorz Sobek, Dimitrios Trichopoulos, Marvin Cervantes-Loaiza, Abu Am Hanif, Elaine M. Murtagh, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Kyungwon Oh, Heiner Boeing, Regina Heidinger-Felso, André Luiz Sena Guimarães, Balkish M. Naidu, Avula Laxmaiah, Ana M. B. Menezes, Marie Eliasen, Francesco Pistelli, Yuan He, Dusko Bjelica, José A. 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Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Eleonora d'Orsi, Irene G. M. van Valkengoed, Anna Fijałkowska, Wen-Harn Pan, Gregor Starc, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Abdullah Alkandari, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Saeed Dastgiri, Lien Braeckevelt, Nasheeta Peer, Radka Taxová Braunerová, Mohamed M. Ali, Steiner Krokstad, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Silvana Donoso, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paola Nardone, Alberto Barceló, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Miquel Porta, Vesna Jureša, Alexander D. Deev, David Faeh, Antonio Bernabe-Ortiz, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Anjani Kumar Jha, Thamara Hubler Figueiró, Jana Kratenova, Claudia M. Hormiga, Maria Tsigga, Zivka Dika, Indrapal I. Meshram, Ei Ei K. Nang, Ian Rouse, Rusidah Selamat, Paul Korrovits, Grethe S. Tell, Julie Taylor, Anabela Mota-Pinto, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Frank J Rühli, Shelly R. McFarlane, Sara Santos Sanz, Edyta Łuszczki, Maria G. Stathopoulou, Tara Coppinger, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. Fuchs, Muhammad Islam, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Maria Ruiz-Castell, Daniela Pierannunzio, Cristina Taddei, Gowri Mahasampath, Gustavo Velasquez-Melendez, Hanna Tolonen, Sudhir Kowlessur, Bagher Larijani, Laura Torres-Collado, Susi Kriemler, Ali Akbar Shayesteh, Cynthia Robitaille, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Line Tang Møllehave, Vincent Jr DeGennaro, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Kodanda R Kanala, Gert B. M. Mensink, Abhijit Sen, Sergej M. Ostojic, Hanan F. Abdul Rahim, Hélène Delisle, Francisco J. Félix-Redondo, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Bethlehem D. Solomon, Erik Lykke Mortensen, Nikhil D. 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Chan School of Public Health, Middlesex University [London], Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Montpellier Interdisciplinary center on Sustainable Agri-food systems (Social and nutritional sciences) (UMR MoISA), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Wellcome TrustEuropean Commission, Clinical Developmental Psychology, APH - Mental Health, Sociology, The Social Context of Aging (SoCA), Nutrition and Health, Iurilli, Maria LC [0000-0003-0409-1635], Zhou, Bin [0000-0002-1741-8628], Ezzati, Majid [0000-0002-2109-8081], Apollo - University of Cambridge Repository, Epidemiology and Data Science, APH - Aging & Later Life, APH - Societal Participation & Health, Public and occupational health, APH - Health Behaviors & Chronic Diseases, VU University medical center, APH 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Medical Research Center, Luxembourg Institute of Health, Bispebjerg and Frederiksberg Hospital, Barcelona Institute for Global Health CIBERESP, World Health Organization Regional Office for the Eastern Mediterranean, Bombay Hospital and Medical Research Centre, Research Center for Social Determinants of Health, UMR CNRS-MNHN 7206 Eco-anthropologie, University of Lille, Lille University Hospital, Western Norway University of Applied Sciences, Norwegian School of Sport Sciences, Madras Diabetes Research Foundation, Zahedan University of Medical Sciences, National Institute of Public Health, Institute of Public Health of the University of Porto, Norwegian Institute of Public Health, University of Massachusetts Amherst, Abt Associates, University of Iceland, University of Yaoundé1, Federal University of Pelotas, University of Medicine 1, Oulu University Hospital, Banska Bystrica Regional Authority of Public Health, Tel- Aviv University, Hebrew University of Jerusalem, University of Porto 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Huiart , Constanta Huidumac Petrescu , Martijn Huisman , Abdullatif Husseini , Chinh Nguyen Huu , Inge Huybrechts , Nahla Hwalla , Jolanda Hyska , Licia Iacoviello , Jesús M Ibarluzea , Mohsen M Ibrahim , Norazizah Ibrahim Wong , M Arfan Ikram , Violeta Iotova , Vilma E Irazola , Takafumi Ishida , Muhammad Islam , Sheikh Mohammed Shariful Islam , Masanori Iwasaki , Jeremy M Jacobs , Hashem Y Jaddou , Tazeen Jafar , Kenneth James , Kazi M Jamil , Konrad Jamrozik , Imre Janszky , Edward Janus , Juel Jarani , Marjo-Riitta Jarvelin , Grazyna Jasienska , Ana Jelakovic , Bojan Jelakovic , Garry Jennings , Anjani Kumar Jha , Chao Qiang Jiang , Ramon O Jimenez , Karl-Heinz Jöckel , Michel Joffres , Mattias Johansson , Jari J Jokelainen , Jost B Jonas , Jitendra Jonnagaddala , Torben Jørgensen , Pradeep Joshi , Farahnaz Joukar , Dragana P Jovic , Jacek J Jóźwiak , Anne Juolevi , Gregor Jurak , Iulia Jurca Simina , Vesna Juresa , Rudolf Kaaks , Felix O Kaducu , Anthony Kafatos , Eero O Kajantie , Zhanna Kalmatayeva , Ofra Kalter-Leibovici , Yves Kameli , Freja B Kampmann , Kodanda R Kanala , Srinivasan Kannan , Efthymios Kapantais , Argyro Karakosta , Line L Kårhus , Khem B Karki , Marzieh Katibeh , Joanne Katz , Peter T Katzmarzyk , Jussi Kauhanen , Prabhdeep Kaur , Maryam Kavousi , Gyulli M Kazakbaeva , Ulrich Keil , Lital Keinan Boker , Sirkka Keinänen-Kiukaanniemi , Roya Kelishadi , Cecily Kelleher , Han Cg Kemper , Andre P Kengne , Maryam Keramati , Alina Kerimkulova , Mathilde Kersting , Timothy Key , Yousef Saleh Khader , Davood Khalili , Kay-Tee Khaw , Bahareh Kheiri , Motahareh Kheradmand , Alireza Khosravi , Ilse Msl Khouw , Ursula Kiechl-Kohlendorfer , Stefan Kiechl , Japhet Killewo , Dong Wook Kim , Hyeon Chang Kim , Jeongseon Kim , Jenny M Kindblom , Heidi Klakk , Magdalena Klimek , Jeannette Klimont , Jurate Klumbiene , Michael Knoflach , Bhawesh Koirala , Elin Kolle , Patrick Kolsteren , Jürgen König , Raija Korpelainen , Paul Korrovits , Magdalena Korzycka , Jelena Kos , Seppo Koskinen , Katsuyasu Kouda , Viktoria A Kovacs , Sudhir Kowlessur , Slawomir Koziel , Jana Kratenova , Wolfgang Kratzer , Susi Kriemler , Peter Lund Kristensen , Steinar Krokstad , Daan Kromhout , Herculina S Kruger , Ruzena Kubinova , Renata Kuciene , Urho M Kujala , Enisa Kujundzic , Zbigniew Kulaga , R Krishna Kumar , Marie Kunešová , Pawel Kurjata , Yadlapalli S Kusuma , Kari Kuulasmaa , Catherine Kyobutungi , Quang Ngoc La , Fatima Zahra Laamiri , Tiina Laatikainen , Carl Lachat , Youcef Laid , Tai Hing Lam , Christina-Paulina Lambrinou , Edwige Landais , Vera Lanska , Georg Lappas , Bagher Larijani , Tint Swe Latt , Laura Lauria , Maria Lazo-Porras , Gwenaëlle Le Coroller , Khanh Le Nguyen Bao , Agnès Le Port , Tuyen D Le , Jeannette Lee , Jeonghee Lee , Paul H Lee , Nils Lehmann , Terho Lehtimäki , Daniel Lemogoum , Naomi S Levitt , Yanping Li , Merike Liivak , Christa L Lilly , Wei-Yen Lim , M Fernanda Lima-Costa , Hsien-Ho Lin , Xu Lin , Yi-Ting Lin , Lars Lind , Allan Linneberg , Lauren Lissner , Mieczyslaw Litwin , Lijuan Liu , Wei-Cheng Lo , Helle-Mai Loit , Khuong Quynh Long , Luis Lopes , Oscar Lopes , Esther Lopez-Garcia , Tania Lopez , Paulo A Lotufo , José Eugenio Lozano , Janice L Lukrafka , Dalia Luksiene , Annamari Lundqvist , Robert Lundqvist , Nuno Lunet , Charles Lunogelo , Michala Lustigová , Edyta Łuszczki , Guansheng Ma , Jun Ma , Xu Ma , George Ll Machado-Coelho , Aristides M Machado-Rodrigues , Luisa M Macieira , Ahmed A Madar , Stefania Maggi , Dianna J Magliano , Sara Magnacca , Emmanuella Magriplis , Gowri Mahasampath , Bernard Maire , Marjeta Majer , Marcia Makdisse , Päivi Mäki , Fatemeh Malekzadeh , Reza Malekzadeh , Rahul Malhotra , Kodavanti Mallikharjuna Rao , Sofia K Malyutina , Lynell V Maniego , Yannis Manios , Jim I Mann , Fariborz Mansour-Ghanaei , Enzo Manzato , Paula Margozzini , Anastasia Markaki , Oonagh Markey , Eliza Markidou Ioannidou , Pedro Marques-Vidal , Larissa Pruner Marques , Jaume Marrugat , Yves Martin-Prevel , Rosemarie Martin , Reynaldo Martorell , Eva Martos , Katharina Maruszczak , Stefano Marventano , Luis P Mascarenhas , Shariq R Masoodi , Ellisiv B Mathiesen , Prashant Mathur , Alicia Matijasevich , Tandi E Matsha , Christina Mavrogianni , Artur Mazur , Jean Claude N Mbanya , Shelly R McFarlane , Stephen T McGarvey , Martin McKee , Stela McLachlan , Rachael M McLean , Scott B McLean , Breige A McNulty , Sounnia Mediene Benchekor , Jurate Medzioniene , Parinaz Mehdipour , Kirsten Mehlig , Amir Houshang Mehrparvar , Aline Meirhaeghe , Jørgen Meisfjord , Christa Meisinger , Ana Maria B Menezes , Geetha R Menon , Gert Bm Mensink , Maria Teresa Menzano , Alibek Mereke , Indrapal I Meshram , Andres Metspalu , Haakon E Meyer , Jie Mi , Kim F Michaelsen , Nathalie Michels , Kairit Mikkel , Karolina Milkowska , Jody C Miller , Cláudia S Minderico , G K Mini , Juan Francisco Miquel , Mohammad Reza Mirjalili , Daphne Mirkopoulou , Erkin Mirrakhimov , Marjeta Mišigoj-Durakovic , Antonio Mistretta , Veronica Mocanu , Pietro A Modesti , Sahar Saeedi Moghaddam , Bahram Mohajer , Mostafa K Mohamed , Shukri F Mohamed , Kazem Mohammad , Zahra Mohammadi , Noushin Mohammadifard , Reza Mohammadpourhodki , Viswanathan Mohan , Salim Mohanna , Muhammad Fadhli Mohd Yusoff , Iraj Mohebbi , Farnam Mohebi , Marie Moitry , Drude Molbo , Line T Møllehave , Niels C Møller , Dénes Molnár , Amirabbas Momenan , Charles K Mondo , Michele Monroy-Valle , Eric Monterrubio-Flores , Kotsedi Daniel K Monyeki , Jin Soo Moon , Mahmood Moosazadeh , Leila B Moreira , Alain Morejon , Luis A Moreno , Karen Morgan , Suzanne N Morin , Erik Lykke Mortensen , George Moschonis , Malgorzata Mossakowska , Aya Mostafa , Anabela Mota-Pinto , Jorge Mota , Mohammad Esmaeel Motlagh , Jorge Motta , Marcos André Moura-Dos-Santos , Malay K Mridha , Kelias P Msyamboza , Thet Thet Mu , Magdalena Muc , Boban Mugoša , Maria L Muiesan , Parvina Mukhtorova , Martina Müller-Nurasyid , Neil Murphy , Jaakko Mursu , Elaine M Murtagh , Kamarul Imran Musa , Sanja Music Milanovic , Vera Musil , Norlaila Mustafa , Iraj Nabipour , Shohreh Naderimagham , Gabriele Nagel , Balkish M Naidu , Farid Najafi , Harunobu Nakamura , Jana Námešná , Ei Ei K Nang , Vinay B Nangia , Martin Nankap , Sameer Narake , Paola Nardone , Matthias Nauck , William A Neal , Azim Nejatizadeh , Chandini Nekkantti , Keiu Nelis , Liis Nelis , Ilona Nenko , Martin Neovius , Flavio Nervi , Chung T Nguyen , Nguyen D Nguyen , Quang Ngoc Nguyen , Ramfis E Nieto-Martínez , Yury P Nikitin , Guang Ning , Toshiharu Ninomiya , Sania Nishtar , Marianna Noale , Oscar A Noboa , Helena Nogueira , Teresa Norat , Maria Nordendahl , Børge G Nordestgaard , Davide Noto , Natalia Nowak-Szczepanska , Mohannad Al Nsour , Irfan Nuhoglu , Eha Nurk , Terence W O'Neill , Dermot O'Reilly , Galina Obreja , Caleb Ochimana , Angélica M Ochoa-Avilés , Eiji Oda , Kyungwon Oh , Kumiko Ohara , Claes Ohlsson , Ryutaro Ohtsuka , Örn Olafsson , Maria 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Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Subjects: Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed
Published: 2021

10. Tdap-HPV vaccination bundling in the USA: Trends, predictors, and implications for vaccine series completion

Author: Yenan Zhu, Chi-Fang Wu, Anna R. Giuliano, Maria E. Fernandez, Ana P. Ortiz, Cecilia Ganduglia Cazaban, Ruosha Li, Ashish A. Deshmukh, and Kalyani Sonawane
Subjects: Adolescent, Epidemiology, Papillomavirus Infections, Vaccination, Public Health, Environmental and Occupational Health, Humans, Female, Papillomavirus Vaccines, Toxoids, Child, United States, Retrospective Studies
Abstract: The Centers for Disease Control and Prevention (CDC) promotes taking a 'bundling approach' (i.e., administering Tetanus, diphtheria toxoids, and acellular pertussis [Tdap] and human papillomavirus [HPV] vaccines in the same way and on the same day) for adolescent vaccinations. Recent trends and patterns in Tdap-HPV vaccination bundling in the USA remain undocumented. In addition, the implications of bundling Tdap-HPV vaccination for HPV vaccine series completion remain unknown. To address these critical knowledge gaps, we performed a retrospective study using a nationwide sample of privately insured adolescents (Optum's de-identified Clinformatics® Data Mart Database). Tdap-HPV vaccination bundling (per 100 Tdap vaccination encounters) during 2014-2018 was estimated overall, for 50 states, and by adolescents' age, sex, and provider specialties. Survival model estimated the likelihood of series completion among 9-14-year-old adolescents. From 2014 to 2018, 560,806 adolescents received a Tdap vaccine of which 172,604 (30.8%) received the HPV vaccines on the same day. Tdap-HPV vaccination bundling (per 100 Tdap vaccinations) increased nationally, from 22.9 in 2014 to 39.1 in 2018 (P
Published: 2021

11. Effect of Hurricane Maria on HPV, Tdap, and meningococcal conjugate vaccination rates in Puerto Rico, 2015-2019

Author: Ana P. Ortiz, Roxana Soto-Abreu, Olga L Díaz-Miranda, Vivian Colón-López, Erick Suárez, Idamaris Vega-Jimenez, and Diana T. Medina-Laabes
Subjects: Male, Adolescent, Immunology, Meningococcal Vaccines, Meningococcal vaccine, Meningococcal conjugate vaccination, Alphapapillomavirus, Rate ratio, Diphtheria-Tetanus-acellular Pertussis Vaccines, Immunology and Allergy, Medicine, Humans, Papillomavirus Vaccines, Papillomaviridae, Immunization Schedule, Pharmacology, Human papilloma virus, business.industry, Cyclonic Storms, Papillomavirus Infections, Puerto Rico, Vaccination, Immunization, Female, business, Demography
Abstract: In September 2017, Hurricane Maria devastated the Caribbean region, among them the US territory of Puerto Rico (PR). Vaccination distribution and uptake suffered from the impact. This study evaluated the trends in monthly vaccination initiation rates for human papilloma virus (HPV), Tdap and meningococcal conjugate (MenACWY) adolescent vaccines from 2015 to 2019, during which it was possible to observe and analyze the impact of Hurricane Maria on vaccine initiation. Monthly initiation rates were estimated. Age-standardized initiation rate ratio (SRR) and 95% CI were estimated. The analysis included 85,340 adolescents; 52.3% were male, and 47.7% were females. September 2017 showed HPV vaccine initiation had the lower rates of all the studied vaccines, with a rate of 75% after the disaster (from a rate of almost 90% in July 2017). Tdap and MenACWY vaccines rates remained above 90% in the same period. The SRR of HPV vaccine for September and October 2017 showed an estimated reduction of 5% and 8% in vaccine initiation rates, respectively for each month, when 2016 was the reference year (p > .05). The SRR of Tdap and MenACWY vaccines for November 2017 showed significant reductions when 2015 and 2016 were reference years (p
Published: 2021

12. ¡Habla de VPH! An Educational Activity for College Students in Puerto Rico

Author: Vivian, Colón-López, Alelí, Ayala-Marín, Camille, Vélez-Alamo, Marievelisse, Soto-Salgado, Lizbeth, Medina-Cortés, Adrianna I, Acevedo-Fontanez, Ana P, Ortiz, Natalie, Fernández-Espada, Marta, Sánchez-Aracil, and Omayra, Salgado-Cruz
Subjects: Male, Health Knowledge, Attitudes, Practice, Adolescent, Universities, Papillomavirus Infections, Puerto Rico, Uterine Cervical Neoplasms, Patient Acceptance of Health Care, Young Adult, Surveys and Questionnaires, Humans, Female, Papillomavirus Vaccines, Students, Program Evaluation
Abstract: To evaluate human papillomavirus (HPV) infection knowledge, willingness to get vaccinated, and vaccination uptake, following a brief educational activity entitled ¡Habla de VPH! (Let's talk about HPV!) in a sample of college students at the University of Puerto Rico, Bayamón.Participants completed a self-administered questionnaire developed by the research team, which gathered information regarding sociodemographic characteristics, HPV vaccination status, and willingness to receive the vaccine. Once the participant completed the survey, the staff of the Outreach Program conducted an educational activity. Study participants completed a pre- and post-test, which included a scale with items related to knowledge about HPV infection, associated malignancies, and the vaccine. To compute the mean knowledge score for each test, the correct responses were summed; the total scores for each test ranged from 0 to 11. Follow-up interviews (3 and 6 months) explored knowledge changes and-in the previously unvaccinated students-vaccine uptake.A total of forty students answered the questionnaire. A significant difference between the average knowledge before (7.6 ± 2.1) and after the intervention (10.6 ±0.6) (P.001) was observed. Of the non-vaccinated group, 59.3% reported being interested in receiving the vaccine. By the 3- and 6-month follow-ups, only 2 students had started the vaccine series.Knowledge about HPV and associated malignancies increased significantly. However, few students initiated the vaccine after either of the followups. Future efforts should line up the vaccine promotion and outreach activities with immunization services, making the vaccine available in the communities to be impacted.
Published: 2021

13. Cervical Cancer Screening Among Medicaid Patients During Natural Disasters and the COVID-19 Pandemic in Puerto Rico, 2016 to 2020

Author: Jeslie M Ramos-Cartagena, Vivian Colón-López, Karen J. Ortiz-Ortiz, Axel Gierbolini-Bermúdez, Ashish A. Deshmukh, Ana P. Ortiz, and Kalyani Sonawane
Subjects: 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Databases, Factual, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Uterine Cervical Neoplasms, Cervical cancer screening, Environmental health, Pandemic, Earthquakes, Research Letter, Medicine, Humans, Mass Screening, Natural disaster, Pandemics, Mass screening, Early Detection of Cancer, Retrospective Studies, business.industry, Cyclonic Storms, Medicaid, SARS-CoV-2, Research, Puerto Rico, COVID-19, General Medicine, United States, Online Only, Female, Public Health, business, geographic locations
Abstract: This cohort study examines rates of cervical cancer screening in Puerto Rico among women with Medicaid health coverage following the 2017 hurricanes, earthquakes in late 2019-2020, and the 2020 COVID-19 lockdown.
Published: 2021

14. Trends in the Incidence of Human Papillomavirus-Associated Cancers by County-Level Income and Smoking Prevalence in the United States, 2000-2018

Author: Yueh-Yun Lin, Haluk Damgacioglu, Ryan Suk, Chi-Fang Wu, Yenan Zhu, Ana P Ortiz, Sehej Kaur Hara, Kalyani Sonawane, and Ashish A Deshmukh
Subjects: Male, Cancer Research, Vulvar Neoplasms, Incidence, Papillomavirus Infections, Smoking, Alphapapillomavirus, Anus Neoplasms, United States, Oncology, Prevalence, Humans, Female, Papillomaviridae
Abstract: Human papillomavirus (HPV)-associated cancer burden is rising in the United States. Trends in the incidence by county-level income and smoking prevalence remain undescribed. We used the Surveillance, Epidemiology, and End Results 21 database to ascertain HPV-associated cancers during 2000-2018. Trends were estimated by county-level income and smoking prevalence quartiles. Anal and vulvar cancer incidence among women and anal cancer incidence among men increased markedly in the lowest-income counties, whereas the increases were slower in the highest-income counties (eg, for vulvar cancer, incidence increased 1.9% per year, 95% confidence interval [CI] = 0.9% to 2.9%, in the lowest-income counties vs 0.8% per year, 95% CI = 0.6% to 1.1%, in the highest-income counties). In recent years, cervical cancer incidence plateaued (0.0% per year [95% CI = −0.5% to 0.5%]) in the highest-income counties; in the lowest-income counties, the annual percentage change was 1.6% per year (95% CI = −0.7% to 4.0%). Counties with high smoking prevalence had marked increases in incidence compared with their counterparts (eg, anal cancer among men increased 4.4% per year [95% CI = 2.7% to 6.0%] for those living in counties with the highest smoking prevalence vs 1.2% per year [95% CI = 0.7% to 1.7%] for those living in counties with the lowest smoking prevalence). Improved and targeted prevention is needed to combat the widening disparities.
Published: 2021

15. Understanding parents’ views toward the newly enacted HPV vaccine school entry policy in Puerto Rico: a qualitative study

Author: Olga L. Díaz Miranda, Roxana Soto Abreu, Ana P. Ortiz, Diana T. Medina-Laabes, Pamela C. Hull, Vivian Colón-López, and Maria E. Fernandez
Subjects: Male, Parents, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, education, Hispanic, HPV vaccines, Medicine, Humans, Misinformation, Papillomavirus Vaccines, Child, School entry policy, HPV vaccine, Schools, business.industry, Public health, Research, Parental perspective, Papillomavirus Infections, Puerto Rico, Vaccination, Public Health, Environmental and Occupational Health, Patient Acceptance of Health Care, Focus group, Policy, Family medicine, Female, Thematic analysis, Public aspects of medicine, RA1-1270, business, Inclusion (education), Qualitative research
Abstract: Background The Human papillomavirus vaccine (HPV) is an essential tool for the prevention of HPV-related cancers. In Puerto Rico, the Secretary of Health established a school entry requirement of at least one dose of HPV vaccination in girls and boys aged 11 and 12 years, taking effect in August 2018. Our study aimed to examine parents’ and guardians’ views of unvaccinated children about the process of implementation of the new HPV vaccination school entry policy in Puerto Rico and identify potential barriers and facilitators related to the implementation of this requirement. Methods During April through November 2019, we conducted three focus groups (n = 12) and eight in-depth semi-structured interviews with parents of children aged 11 and 12 who had not yet initiated the HPV vaccine series. The interview topics addressed were: perception of vaccination, HPV vaccine and it is inclusion as new school entry requirement practice, procedure of the sources of information, influencers, and willingness to change. The interviews were recorded and transcribed by our staff members. We identified emergent themes through thematic analysis. Results The participants’ perspective on the HPV vaccine school requirement was mixed. Lack of information of the HPV vaccines and lack of communication about the school-entry requirement were the themes most mentioned in the interviews. Moreover, previous negative experiences from friends or family members and adverse effects deterred some participants from vaccinating their kids. We discussed barriers in the process of soliciting an exemption. Conclusion Most barriers mentioned by study participants are modifiable. Information about the HPV vaccine mandate’s implementation and educational materials regarding HPV vaccine safety need to be provided to address parents’ concerns related to the vaccine’s side effects. Schools (teachers, principal directors, and administrative staff), the government, and parent organizations need to be part of these efforts. This multilevel approach will help to improve disseminating information about HPV vaccination to clarify doubts and misinformation among parents.
Published: 2021

16. Cancer statistics for the US Hispanic/Latino population, 2021

Author: Stacey A. Fedewa, Priti Bandi, Hannah E. Fuchs, Ahmedin Jemal, Rebecca L. Siegel, Paulo S. Pinheiro, Adair K. Minihan, Dinorah Martinez Tyson, Ana P. Ortiz, Guillermo Tortolero-Luna, and Kimberly D. Miller
Subjects: Adult, Male, Adolescent, Population, Rate ratio, Health Services Accessibility, White People, Young Adult, Breast cancer, Risk Factors, Neoplasms, Medicine, Humans, Young adult, education, Stomach cancer, Survival rate, Early Detection of Cancer, Aged, education.field_of_study, business.industry, Incidence (epidemiology), Incidence, Puerto Rico, Cancer, Hematology, Hispanic or Latino, Middle Aged, medicine.disease, United States, Survival Rate, Oncology, Female, business, Demography
Abstract: The Hispanic/Latino population is the second largest racial/ethnic group in the continental United States and Hawaii, accounting for 18% (60.6 million) of the total population. An additional 3 million Hispanic Americans live in Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanic individuals in the United States using the most recent population-based data. An estimated 176,600 new cancer cases and 46,500 cancer deaths will occur among Hispanic individuals in the continental United States and Hawaii in 2021. Compared to non-Hispanic Whites (NHWs), Hispanic men and women had 25%-30% lower incidence (2014-2018) and mortality (2015-2019) rates for all cancers combined and lower rates for the most common cancers, although this gap is diminishing. For example, the colorectal cancer (CRC) incidence rate ratio for Hispanic compared with NHW individuals narrowed from 0.75 (95% CI, 0.73-0.78) in 1995 to 0.91 (95% CI, 0.89-0.93) in 2018, reflecting delayed declines in CRC rates among Hispanic individuals in part because of slower uptake of screening. In contrast, Hispanic individuals have higher rates of infection-related cancers, including approximately two-fold higher incidence of liver and stomach cancer. Cervical cancer incidence is 32% higher among Hispanic women in the continental US and Hawaii and 78% higher among women in Puerto Rico compared to NHW women, yet is largely preventable through screening. Less access to care may be similarly reflected in the low prevalence of localized-stage breast cancer among Hispanic women, 59% versus 67% among NHW women. Evidence-based strategies for decreasing the cancer burden among the Hispanic population include the use of culturally appropriate lay health advisors and patient navigators and targeted, community-based intervention programs to facilitate access to screening and promote healthy behaviors. In addition, the impact of the COVID-19 pandemic on cancer trends and disparities in the Hispanic population should be closely monitored.
Published: 2021

17. Effect of an Educational Video to Increase Calls and Screening into an Anal Cancer Clinical Trial Among HIV+ Hispanics in PR: Results from a Randomized Controlled Behavioral Trial

Author: Marievelisse Soto-Salgado, Moon S. Chen, Mark Machin, Darilyn Rivera-Collazo, Vivian Colón-López, Ana P. Ortiz, Hilmaris Centeno-Girona, and Daisy González
Subjects: Adult, Male, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Social Psychology, Population, Video Recording, HIV Infections, Health Promotion, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Internal medicine, medicine, Humans, Anal cancer, 030212 general & internal medicine, education, Early Detection of Cancer, education.field_of_study, 030505 public health, medicine.diagnostic_test, business.industry, Public health, Incidence (epidemiology), Puerto Rico, Public Health, Environmental and Occupational Health, Anoscopy, Hispanic or Latino, Middle Aged, Anus Neoplasms, medicine.disease, nervous system diseases, Clinical trial, Health psychology, Infectious Diseases, Female, 0305 other medical science, business, Program Evaluation
Abstract: Anal cancer incidence is higher in persons living with HIV/AIDS (PLWHA) than in the general population. Participation of PLWHA in anal cancer clinical trials (CTs) is essential; Hispanic PLWHA are underrepresented in CTs. We conducted a behavioral CT among 305 PLWHA in Puerto Rico to measure the efficacy of an educational video in increasing calls and screening into an anal cancer CT. Participants received printed educational materials on anal cancer and CTs; the intervention group also received an educational video. Outcome assessment based on follow-up interviews showed that printed materials increased awareness about CTs and high-resolution anoscopy (HRA), and willingness to participate in an anal cancer CT in both groups. However, the addition of the video increased the likelihood of participants to call the CT for orientation (RRadjusted = 1.66, 95% CI 1.00–2.76; p = 0.05) and pre-screening evaluation (RRadjusted = 1.70, 95% CI 0.95–3.03; p = 0.07). This intervention could help increase participation of Hispanics into anal cancer-related CTs.
Published: 2018

18. Disparities in human papillomavirus–related cancer incidence and survival among human immunodeficiency virus–infected Hispanics living in the United States

Author: Marievelisse Soto‐Salgado, Vivian Colón-López, Graciela M. Nogueras-Gonzalez, Meredith S. Shiels, Mark Machin, Alicia Vargas, Ana P. Ortiz, and Eric A. Engels
Subjects: Adult, Male, Cancer Research, Adolescent, Population, Uterine Cervical Neoplasms, HIV Infections, Comorbidity, White People, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), medicine, Humans, Anal cancer, 030212 general & internal medicine, Healthcare Disparities, Young adult, education, Penile Neoplasms, Aged, Proportional Hazards Models, Cervical cancer, education.field_of_study, Vulvar Neoplasms, business.industry, Incidence, Incidence (epidemiology), Papillomavirus Infections, Hazard ratio, virus diseases, Cancer, Hispanic or Latino, Middle Aged, Anus Neoplasms, Prognosis, medicine.disease, Survival Analysis, United States, Black or African American, Oncology, 030220 oncology & carcinogenesis, Female, business, Demography
Abstract: Background Human papillomavirus (HPV) causes 10% of cancers among human immunodeficiency virus (HIV)-infected people in the United States. Because Hispanics are disproportionally affected by the HIV epidemic and by infection-related cancers, this study compared incidence rates for HPV-related cancers and survival between Hispanics and non-Hispanic whites (NHWs) and non-Hispanic blacks (NHBs) in the HIV-infected US population. Methods Based on data from the HIV/AIDS Cancer Match Study, standardized incidence ratios (SIRs) were used to estimate cancer risk in HIV-infected Hispanics and the general US Hispanic population. Among HIV-infected people, cancer rates were compared with incidence rate ratios (IRRs), and survival was compared with hazard ratios between Hispanics and NHWs and NHBs. Results Five hundred two HPV-related cancers occurred in 864,067 person-years of follow-up among HIV-infected Hispanics. Except for oropharyngeal cancer, the risk of HPV-related cancers was higher among HIV-infected Hispanics than in the general population (SIR range, 3.59 [cervical cancer] to 18.7 [anal cancer in men]). Among HIV-infected females, Hispanics had higher cervical cancer rates than NHWs (IRR, 1.70; 95% confidence interval [CI], 1.19-2.43) but lower vulvar cancer rates than NHWs (IRR, 0.40; 95% CI, 0.24-0.67) and NHBs (IRR, 0.62; 95% CI, 0.41-0.95). Among HIV-infected males, Hispanics had higher penile cancer rates than NHWs (IRR, 2.60; 95% CI, 1.36-4.96) but lower anal cancer rates than NHWs (IRR, 0.54; 95% CI, 0.46-0.63) and NHBs (IRR, 0.65; 95% CI, 0.56-0.77). Among HIV-infected Hispanics, 5-year survival was greater than 50% across HPV-related cancer types, with no major differences by racial/ethnic group. Conclusions HIV-infected Hispanics have an elevated risk for HPV-related cancers. Similarly to the general population, HIV-infected Hispanics have higher rates of cervical and penile cancer than NHWs and NHBs. HPV vaccination should be promoted among HIV-infected individuals to reduce the burden of HPV-related cancers.
Published: 2018

19. Cancer Statistics for Hispanics/Latinos, 2018

Author: Ann Goding Sauer, Dinorah Martinez-Tyson, Paulo S. Pinheiro, Kimberly D. Miller, Stacey A. Fedewa, Guillermo Tortolero-Luna, Ana P. Ortiz, Rebecca L. Siegel, and Ahmedin Jemal
Subjects: Male, Minority group, Ethnic group, White People, 03 medical and health sciences, Prostate cancer, 0302 clinical medicine, Risk Factors, Neoplasms, Prevalence, medicine, Humans, 030212 general & internal medicine, Lung cancer, Cause of death, business.industry, Incidence, Incidence (epidemiology), Mortality rate, Puerto Rico, Cancer, Health Status Disparities, Hispanic or Latino, Hematology, Middle Aged, medicine.disease, United States, Survival Rate, Oncology, 030220 oncology & carcinogenesis, Female, business, SEER Program, Demography
Abstract: Cancer is the leading cause of death among Hispanics/Latinos, who represent the largest racial/ethnic minority group in the United States, accounting for 17.8% (57.5 million) of the total population in the continental United States and Hawaii in 2016. In addition, more than 3 million Hispanic Americans live in the US territory of Puerto Rico. Every 3 years, the American Cancer Society reports on cancer occurrence, risk factors, and screening for Hispanics in the United States based on data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention. For the first time, contemporary incidence and mortality rates for Puerto Rico, which has a 99% Hispanic population, are also presented. An estimated 149,100 new cancer cases and 42,700 cancer deaths will occur among Hispanics in the continental United States and Hawaii in 2018. For all cancers combined, Hispanics have 25% lower incidence and 30% lower mortality compared with non-Hispanic whites, although rates of infection-related cancers, such as liver, are up to twice as high in Hispanics. However, these aggregated data mask substantial heterogeneity within the Hispanic population because of variable cancer risk, as exemplified by the substantial differences in the cancer burden between island Puerto Ricans and other US Hispanics. For example, during 2011 to 2015, prostate cancer incidence rates in Puerto Rico (146.6 per 100,000) were 60% higher than those in other US Hispanics combined (91.6 per 100,000) and 44% higher than those in non-Hispanic whites (101.7 per 100,000). Prostate cancer is also the leading cause of cancer death among men in Puerto Rico, accounting for nearly 1 in 6 cancer deaths during 2011-2015, whereas lung cancer is the leading cause of cancer death among other US Hispanic men combined. Variations in cancer risk are driven by differences in exposure to cancer-causing infectious agents and behavioral risk factors as well as the prevalence of screening. Strategies for reducing cancer risk in Hispanic populations include targeted, culturally appropriate interventions for increasing the uptake of preventive services and reducing cancer risk factor prevalence, as well as additional funding for Puerto Rico-specific and subgroup-specific cancer research and surveillance.
Published: 2018

20. Knowledge, Attitudes, and Experiences of Anal Cancer and Anal Cancer Screening Among a Clinical Sample of Hispanic Women

Author: Lianeris M Estremera-Rodríguez, Ana P. Ortiz, Kyara M Berríos-Toledo, Jeslie M Ramos-Cartagena, Sandra I García-Camacho, Vivian Colón-López, and Josefina Romaguera
Subjects: Adult, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Population, Organ transplantation, Article, Interviews as Topic, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Risk Factors, Medicine, Anal cancer, Humans, Medical history, Pap test, education, Early Detection of Cancer, Aged, Colposcopy, education.field_of_study, 030219 obstetrics & reproductive medicine, medicine.diagnostic_test, business.industry, Obstetrics, Puerto Rico, Obstetrics and Gynecology, Anoscopy, General Medicine, Middle Aged, medicine.disease, Anus Neoplasms, Cross-Sectional Studies, 030220 oncology & carcinogenesis, Population study, Female, business, Papanicolaou Test
Abstract: OBJECTIVE: Anal cancer screening has been recommended for women with lower genital tract neoplasia (LGTN), lupus, Crohn’s disease, human immunodeficiency virus (HIV) and/or organ transplantation recipients. This study described and compared knowledge, attitudes, and experiences related to anal cancer and anal cancer screening between women at high-risk for anal cancer and their counterparts. METHODS: This is a Cross-sectional study within colposcopy and gynecology oncology clinics in Puerto Rico; 283 women aged ≥21 years or older and with prior diagnosis of gynecological neoplasia completed an interviewer-administered questionnaire. Women were categorized according to their medical history as being high-risk or non-high-risk for anal cancer. The high-risk group included women with history of lower genital tract neoplasia, lupus, Crohn’s disease, HIV and/or organ transplantation. RESULTS: Overall, 40.7% of the study population were at high-risk of developing anal cancer. History of anal cancer screening was low among high-risk and non-high-risk women (11.5 vs. 5.6%, p>0.05). Less than 1% of all women reported to have had a high-resolution anoscopy. Most women (87.6%) had little knowledge about anal Pap: test but were willing to have one if their doctors recommended it (96.5%). No major differences in knowledge, attitudes or screening history were observed between high-risk and non-high-risk women. CONCLUSION: Although experts do not recommend routine anal cancer screening for the general population, they do recommend it for women within certain high-risk groups. Study findings highlight the importance of increasing education and awareness of anal cancer among high-risk patients and physicians, to promote better preventive methods, achieve early detection and improve disease outcomes.
Published: 2021

21. Squamous Cell Carcinoma of the Anus Incidence, Mortality, and Survival Among the General Population and Persons Living With HIV in Puerto Rico, 2000-2016

Author: Vivian Colón-López, Jeslie M Ramos-Cartagena, Ashish A. Deshmukh, Karen J. Ortiz-Ortiz, Ana P. Ortiz, and Carlos R. Torres-Cintrón
Subjects: Male, Cancer Research, Population, MEDLINE, Human immunodeficiency virus (HIV), Anal Canal, HIV Infections, medicine.disease_cause, Cancer Prevention and Control, 03 medical and health sciences, Sexual and Gender Minorities, 0302 clinical medicine, Medicine, Humans, Basal cell, 030212 general & internal medicine, Homosexuality, Male, education, education.field_of_study, business.industry, Incidence (epidemiology), Incidence, Puerto Rico, ORIGINAL REPORTS, Anus, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Carcinoma, Squamous Cell, business, Demography
Abstract: PURPOSE Squamous cell carcinoma of the anus (SCCA) is common among persons living with HIV (PLWH). We described SCCA incidence and survival among the general population and among PLWH in Puerto Rico (PR), along with mortality of anal cancer. METHODS PR HIV/AIDS Surveillance Program and the PR Central Cancer Registry databases were linked (2000-2016). Incidence rates (IRs) and trends (annual percent change [APC]) in SCCA and mortality rates and trends for anal cancer were estimated. Relative survival and relative excess risk (RER) of death were calculated. RESULTS From 2000 to 2016, 991 individuals in PR were diagnosed with anal cancer; 73% of cases were SCCA 9.1% of SCCA and 1.5% of non-SCCA cases were in PLWH ( P < .0001). SCCA incidence was higher among PLWH than the general population (IR = 27.7/100,000). Among PLWH, SCCA incidence (per 100,000) was the highest among men who have sex with men (IR = 60.5). From 2001-2016, SCCA incidence increased among the general population (APC: 4.90, P < .05); however, no significant change was observed among PLWH (APC = 0.19 and P = .96). The APC for anal cancer mortality in the general population was positive (3.9%) from 2000 to 2016, but not significant ( P > .05). The 5-year relative survival of SCCA was 56.9% among PLWH and 66.8% among the general population. In multivariate analysis, the RER of death for SCCA 5 years postdiagnosis was affected by stage at diagnosis (distant: RER = 7.6, 95% CI, 2.36 to 24.25) but not by PLWH status (RER = 1.4, 95% CI, 0.67 to 3.01). CONCLUSION Our findings highlight the relevance of anal cancer screening in PLWH and HPV vaccination in both PLWH and the general population in PR, which could have an impact on the disease trend in the next few decades.
Published: 2021

22. Incidence of Cervical Cancer in Puerto Rico, 2001-2017

Author: Chi Fang Wu, Guillermo Tortolero-Luna, Vivian Colón-López, Karen J. Ortiz-Ortiz, Ana P. Ortiz, Carlos R. Torres-Cintrón, and Ashish A. Deshmukh
Subjects: Cancer Research, medicine.medical_specialty, education, MEDLINE, Uterine Cervical Neoplasms, behavioral disciplines and activities, 03 medical and health sciences, 0302 clinical medicine, Research Letter, Medicine, Humans, 030212 general & internal medicine, Cervical cancer, business.industry, Obstetrics, Incidence (epidemiology), Incidence, Puerto Rico, virus diseases, medicine.disease, humanities, Oncology, 030220 oncology & carcinogenesis, Female, business, Birth cohort, geographic locations, Cohort study
Abstract: This cohort study examines recent trajectories in the incidence of cervical cancer in Puerto Rico by age and among birth cohorts.
Published: 2021

23. Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29 900 men according to HIV status, sexuality, and age: a collaborative pooled analysis of 64 studies

Author: Stephen E Hawes, Isabelle Etienney, Joaquín Burgos, Maria Gabriella Donà, Vitaly Smelov, Carmen Hidalgo-Tenorio, Gad Murenzi, Alexandra de Pokomandy, Andrew C. Hickey, Suwat Chariyalertsak, Nittaya Phanuphak, Gary M. Clifford, Huachun Zou, Nicolas Wentzensen, Simbarashe Chinyowa, Gypsyamber D'Souza, Eric P F Chow, Alice M. Schofield, Evy Yunihastuti, Yoojin Choi, Alexandra L. Hernandez, Stephen E. Goldstone, Hélène Péré, Elissa Meites, Yifei Hu, Petra J. Woestenberg, Rebecca G. Nowak, Marleny Valencia Arredondo, Jason J. Ong, Xing Liu, Lei Gao, Ulrike Wieland, Anna R. Giuliano, Feixue Wei, Mauricio Iribarren Díaz, Shu Hsing Cheng, Ningshao Xia, Catharina J Alberts, Jianghong Dai, Yin Ling Woo, Admire Chikandiwa, Michael M. Gaisa, Carol Strong, Marta del Pino, Angella Charnot-Katsikas, Karin Neukam, Maarten F. Schim van der Loeff, Timothy J. Wilkin, I. Mary Poynten, Alan G. Nyitray, Ana P. Ortiz, Michel Segondy, Jean Damien Combes, Valentine Marie Ferré, International Agency for Research on Cancer, Institut Català de la Salut, [Wei F] Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France. [Gaisa MM] Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA. [D'Souza G] Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. [Xia N] State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China. [Giuliano AR] Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA. [Hawes SE] Department of Epidemiology, Department of Health Services, and Department of Global Health, University of Washington, Seattle, WA, USA. [Burgos J] Servei de Malalties Infeccioses, Vall d'Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Infectious diseases, AII - Infectious diseases, APH - Global Health, and APH - Methodology
Subjects: Male, medicine.medical_specialty, virosis::infecciones por virus ADN::infecciones por Papillomavirus [ENFERMEDADES], Epidemiology, Squamous Intraepithelial Lesions, Immunology, Anal Canal, Human sexuality, HIV Infections, Virus Diseases::DNA Virus Infections::Papillomavirus Infections [DISEASES], Men who have sex with men, Risk Factors, Virology, Prevalence, Medicine, Anal cancer, Humans, Malalties transmissibles, Homosexuality, Male, Papil·lomavirus, Papillomaviridae, business.industry, Papillomavirus Infections, Age Factors, HPV infection, virus diseases, Articles, medicine.disease, Anus Neoplasms, Vaccination, Infectious Diseases, Pooled analysis, Hiv status, business, Sexuality, Demography
Abstract: [Background] Robust age-specific estimates of anal human papillomavirus (HPV) and high-grade squamous intraepithelial lesions (HSIL) in men can inform anal cancer prevention efforts. We aimed to evaluate the age-specific prevalence of anal HPV, HSIL, and their combination, in men, stratified by HIV status and sexuality., [Methods] We did a systematic review for studies on anal HPV infection in men and a pooled analysis of individual-level data from eligible studies across four groups: HIV-positive men who have sex with men (MSM), HIV-negative MSM, HIV-positive men who have sex with women (MSW), and HIV-negative MSW. Studies were required to inform on type-specific HPV infection (at least HPV16), detected by use of a PCR-based test from anal swabs, HIV status, sexuality (MSM, including those who have sex with men only or also with women, or MSW), and age. Authors of eligible studies with a sample size of 200 participants or more were invited to share deidentified individual-level data on the above four variables. Authors of studies including 40 or more HIV-positive MSW or 40 or more men from Africa (irrespective of HIV status and sexuality) were also invited to share these data. Pooled estimates of anal high-risk HPV (HR-HPV, including HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68), and HSIL or worse (HSIL+), were compared by use of adjusted prevalence ratios (aPRs) from generalised linear models., [Findings] The systematic review identified 93 eligible studies, of which 64 contributed data on 29 900 men to the pooled analysis. Among HIV-negative MSW anal HPV16 prevalence was 1·8% (91 of 5190) and HR-HPV prevalence was 6·9% (345 of 5003); among HIV-positive MSW the prevalences were 8·7% (59 of 682) and 26·9% (179 of 666); among HIV-negative MSM they were 13·7% (1455 of 10 617) and 41·2% (3798 of 9215), and among HIV-positive MSM 28·5% (3819 of 13 411) and 74·3% (8765 of 11 803). In HIV-positive MSM, HPV16 prevalence was 5·6% (two of 36) among those age 15–18 years and 28·8% (141 of 490) among those age 23–24 years (ptrend=0·0091); prevalence was 31·7% (1057 of 3337) among those age 25–34 years and 22·8% (451 of 1979) among those age 55 and older (ptrend, [Interpretation] High anal HPV prevalence among young HIV-positive and HIV-negative MSM highlights the benefits of gender-neutral HPV vaccination before sexual activity over catch-up vaccination. HIV-positive MSM are a priority for anal cancer screening research and initiatives targeting HPV16-positive HSIL+., International Agency for Research on Cancer.
Published: 2021

24. Disruptions in Oncology Care Confronted by Patients with Gynecologic Cancer Following Hurricanes Irma and Maria in Puerto Rico

Author: William A. Calo, Mirza Rivera, Pablo A. Mendez-Lazaro, Sandra I. Garcia-Camacho, Yanina M. Bernhardt Utz, Edna Acosta-Perez, and Ana P. Ortiz
Subjects: Oncology, Cyclonic Storms, Neoplasms, Puerto Rico, Humans, Female, Hematology, General Medicine, Delivery of Health Care
Abstract: Background In September 2017, hurricanes Irma and Maria affected Puerto Rico (PR) and the US Virgin Islands (USVI), causing major disruptions in basic services and health care. This study documented the stressors and experiences of patients with gynecologic cancer receiving oncology care in PR following these hurricanes. Methods We conducted 4 focus groups (December 2018-April 2019) among women aged ≥21 years from PR who were diagnosed with gynecological cancer between September 2016 and September 2018 (n = 24). Using the same eligibility criteria, we also interviewed patients from the USVI (n = 2) who were treated in PR. We also conducted key-informant interviews with oncology care providers and administrators (n = 23) serving gynecologic cancer patients in PR. Discussions were audio-recorded, transcribed verbatim, and coded to identify emergent themes using a constant comparison method. Results Analyses of focus group discussions and interviews allowed us to identify the following emergent themes: 1) disruptions in oncology care were common; 2) communication between oncology providers and patients was challenging before and after the hurricanes hit; 3) patient resilience was key to resume care; and 4) local communities provided much-needed social support and resources. Conclusions This study provides firsthand information about the disruptions in oncology care experienced by and the resiliency of women with gynecologic cancer following hurricanes Irma and Maria. Our findings underscore the need to incorporate oncology care in the preparedness and response plans of communities, health systems, and government agencies to maintain adequate care for cancer patients during and after disasters such as hurricanes.
Published: 2022

25. Content Analysis of Digital Media Coverage of the Human Papillomavirus Vaccine School-Entry Requirement Policy in Puerto Rico

Author: Vilnery Rivera-Figueroa, Roxana Soto-Abreu, Vivian Colón-López, Coralia Vázquez-Otero, Ana P. Ortiz, Diana T. Medina-Laabes, Pamela C. Hull, Glizette O Arroyo-Morales, Katelyn B Wells, Olga L Díaz-Miranda, and Manuel E Rivera-Encarnación
Subjects: medicine.medical_specialty, Human papillomavirus, Grounded theory, Digital media, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, Humans, Papillomavirus Vaccines, 030212 general & internal medicine, Child, Internet, Schools, Cancer prevention, business.industry, Public health, Papillomavirus Infections, Vaccination, Puerto Rico, Public Health, Environmental and Occupational Health, School-entry policy requirements, Public relations, United States, HPV vaccine implementation, Policy, Content analysis, 030220 oncology & carcinogenesis, Biostatistics, Public aspects of medicine, RA1-1270, business, Research Article
Abstract: Background In August 2018, Puerto Rico (PR) became the 4th state or territory in the United States to adopt a human papillomavirus (HPV) vaccine school-entry requirement, for students 11–12 years old. Evidence suggests that the content of media coverage may impact people’s perception of HPV vaccine and their willingness to vaccinate. This study aimed to analyze the content of digital news coverage related to the implementation of the policy in PR. Methods A content review was conducted of digital media published from January 2017 through December 2018. The content reviewed was carried out in two steps: 1) creating a matrix to summarize each article’s content about the policy and 2) qualitative analysis using a grounded theory approach. Results The search resulted in 34 articles obtained from 17 online local and international news outlets that reported the policy's implementation. Analyses showed that 61% of the news articles did not mention the number of required doses, and 79% discussed the new policy concerning cancer prevention. In 2017, news coverage focused mostly on describing the policy, while 2018 coverage focused on controversies surrounding the implementation. Neutral emergent codes included: 1) Description of the policy; 2) Information about HPV related cancers; and 3) General information about HPV vaccine. Negative emergent codes included: 1) infringement to patient and parental autonomy; 2) Hesitancy from the political sector, and 3) Hesitancy from groups and coalitions. Positive content included: 1) knowledge and acceptance of HPV vaccine for cancer prevention; 2) importance of education and protective sexual behaviors; and 3) new vaccination law proposal. Conclusions Most of the media coverage in PR was neutral and included limited information related to the vaccine, HPV, and HPV-related cancers. Neutral and negative themes could influence public concerns regarding the new policy, as well as HPV vaccination rates in PR.
Published: 2020

26. Chlamydia Trachomatis and Human Papillomavirus Serostatus in Puerto Rican Women

Author: Maira A, Castañeda-Avila, Erick, Suárez-Pérez, Raúl, Bernabe-Dones, Elizabeth R, Unger, Gitika, Panicker, and Ana P, Ortiz
Subjects: Adult, Adolescent, Incidence, Papillomavirus Infections, Puerto Rico, virus diseases, Chlamydia trachomatis, Enzyme-Linked Immunosorbent Assay, Alphapapillomavirus, Chlamydia Infections, Middle Aged, female genital diseases and pregnancy complications, Article, Young Adult, Cross-Sectional Studies, Seroepidemiologic Studies, Prevalence, Humans, Female
Abstract: OBJECTIVE: There is a high prevalence of human papillomavirus (HPV) infection in Puerto Rico, but little is known about the prevalence of Chlamydia trachomatis (CT) infection in healthy Puerto Rican women. Thus we aimed to evaluate the seroprevalence and association and the association between HPV and CT. METHODS: This was a secondary data analysis from a cross-sectional, population-based, study of HPV infection in women aged 16-64 years in Puerto Rico (2010-2013). Enzyme-linked immunosorbent assays (ELISA) were used to detect serum antibodies to CT and HPV. Logistic regression models were used to estimate the odds ratio (OR) for the association between HPV and CT serostatus. RESULTS: The study included 524 women; mean age was 42 years. Overall, 97 (18.5%) women were CT-seropositive, 251 (47.0%) were HPV seropositive, and 57 (10.9%) had antibodies for both CT and HPV. Women who were CT-seropositive were more likely (p
Published: 2020

27. HPV knowledge, vaccine knowledge, and vaccine acceptance in women with cervical cytology anomalies attending colposcopy clinics in Puerto Rico

Author: Jose Nieves-Muñoz, Jaime A. Roura-Monllor, Josefina Romaguera, and Ana P. Ortiz
Subjects: Adult, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Uterine Cervical Neoplasms, Logistic regression, Ambulatory Care Facilities, Odds, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, 030225 pediatrics, medicine, Humans, Papillomavirus Vaccines, 030212 general & internal medicine, Aged, Cervical cancer, Colposcopy, Descriptive statistics, medicine.diagnostic_test, Obstetrics, business.industry, Papillomavirus Infections, Puerto Rico, Vaccination, Obstetrics and Gynecology, General Medicine, Middle Aged, medicine.disease, Cross-Sectional Studies, Logistic Models, Population study, Female, business, Hpv knowledge
Abstract: OBJECTIVE To assess HPV knowledge as well as knowledge and acceptance of HPV vaccines. METHODS The present cross-sectional study surveyed women with cervical cytology anomalies referred to colposcopy clinics at the University of Puerto Rico and San Juan City Hospital between November 1, 2013, and November 30, 2015. The data were analyzed using descriptive statistics and multivariate logistic regression models. RESULTS Of 418 participants, 333 had heard of HPV. Of these, 273 of 331 (82.5%) knew it causes cervical cancer and 284 of 332 (85.8%) knew it is sexually transmitted; 313 were aware of the vaccine(s). Of 278 participants, 270 (97.1%) were willing to vaccinate their children and 125 of 285 (43.9%) desired vaccination. Only 13 (10.9%) of 119 age-eligible women had been vaccinated. Women who had completed high school had increased odds of having heard of HPV (adjusted OR 2.3, 95% CI 1.2-4.4; P=0.014), with a similar increase in the odds of having heard of the vaccine(s). Women who knew about HPV had greatly increased odds of knowing about the vaccine(s) (adjusted OR 19.7, 95% CI 9.8-41.6). CONCLUSION Knowledge of HPV and HPV vaccine(s) was high, but vaccine uptake was low in the study population. Physicians' active roles in HPV education and vaccination are crucial.
Published: 2018

28. Risk of Anal Cancer in Women With a Human Papillomavirus–Related Gynecological Neoplasm: Puerto Rico 1987–2013

Author: Carlos R Torres Cintrón, Ana P. Ortiz, Erick Suárez, and Adrianna I Acevedo-Fontanez
Subjects: medicine.medical_specialty, Uterine Cervical Neoplasms, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Vulvar Tumor, Humans, Medicine, Anal cancer, Neoplasm, 030212 general & internal medicine, Human papillomavirus, Aged, Retrospective Studies, Vulvar Neoplasms, business.industry, Obstetrics, Incidence, Incidence (epidemiology), Papillomavirus Infections, Puerto Rico, virus diseases, Obstetrics and Gynecology, Retrospective cohort study, General Medicine, Middle Aged, Anus Neoplasms, medicine.disease, female genital diseases and pregnancy complications, 030220 oncology & carcinogenesis, Female, business, Risk assessment, geographic locations
Abstract: The aim of the study was to estimate the magnitude of the association between HPV-related gynecological neoplasms and secondary anal cancer among women in Puerto Rico (PR).We identified 9,489 women who had been diagnosed with a primary cervical, vaginal, or vulvar tumor during 1987-2013. To describe the trends of invasive cervical, vulvar, vaginal, and anal cancer, the age-adjusted incidence rates were estimated using the direct method (2000 US as Standard Population). Standardized incidence ratios (observed/expected) were computed using the indirect method; expected cases were calculated using 2 methods based on age-specific rates of anal cancer in PR. The ratio of standardized incidence ratios of anal cancer was estimated using the Poisson regression model to estimate the magnitude of the association between HPV-gynecologic neoplasms and secondary anal cancer.A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (annual percent change = 1.1, p.05), whereas from 2004 to 2013, an increase was observed for cervical cancer incidence (annual percent change = 3.3, p.05). The risk of secondary anal cancer among women with HPV-related gynecological cancers was approximately 3 times this risk among women with non-HPV-related gynecological cancers (relative risk = 3.27, 95% CI = 1.37 to 7.79).Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at higher risk of secondary anal cancer as compared with women from the general population and with those with non-HPV-related gynecological cancers. Appropriate anal cancer screening guidelines for high-risk populations are needed, including women with HPV-related gynecological malignancies and potentially other cancer survivors.
Published: 2018

29. Association of marijuana use with oral HPV infection and periodontitis among Hispanic adults: Implications for oral cancer prevention

Author: Daisy González, Cynthia M. Pérez, Cristina Muñoz, Jeslie Ramos, Juan Carlos Reyes, and Ana P. Ortiz
Subjects: Adult, medicine.medical_specialty, National Health and Nutrition Examination Survey, Binge drinking, Logistic regression, Severe periodontitis, Article, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Prevalence, medicine, Humans, 030212 general & internal medicine, Periodontitis, business.industry, Public health, Papillomavirus Infections, Puerto Rico, Cancer, Hispanic or Latino, 030206 dentistry, Periodontology, Nutrition Surveys, medicine.disease, Cross-Sectional Studies, Periodontics, Marijuana Use, Mouth Neoplasms, business
Abstract: Background Despite limited data, research suggests that marijuana use is associated with oral HPV infection and periodontitis, two potential oropharyngeal cancer risk factors. We assessed these associations in a Hispanic adult population in Puerto Rico. Methods A cross-sectional study of 735 adults assessed marijuana use, determined through an audio computer-assisted self-interview, and periodontitis and self-collection of oral HPV samples following the National Health and Nutrition Examination Survey methodology. The Centers of Disease Control and Prevention/American Academy of Periodontology definition was used for periodontitis. HPV typing was performed using polymerase chain reaction with modified L1 consensus primers (MY09/MY11). Results 26.5% of adults reported lifetime use of marijuana, 2.7% were frequent users (lifetime use ≥ 26 times, past year use ≥ 6 times, and past 30-day use ≥2 times), 5.7% had oral HPV infection, and 20.1% had severe periodontitis. The multivariate logistic regression analysis showed that frequent marijuana users were more likely to have severe periodontitis (OR = 2.91, 95%CI = 1.06 – 7.96) than never/once lifetime users after adjusting for age, sex, healthcare coverage, smoking, binge drinking, number of oral sex partners, and oral HPV infection. However, frequent marijuana use was not associated with oral HPV infection. Conclusion Marijuana use was associated with periodontitis, but not with oral HPV infection. Further evaluation of the role of marijuana use in oral HPV infection and periodontitis may inform novel preventive public health strategies, as marijuana users could be at increased risk of oral cancer. This article is protected by copyright. All rights reserved
Published: 2018

30. Anal Cancer Risk Among People With HIV Infection in the United States

Author: Howard D. Strickler, Meredith S. Shiels, Philip E. Castle, Eric A. Engels, Mark Machin, Ruth M. Pfeiffer, Ana P. Ortiz, and Vivian Colón-López
Subjects: Adult, Male, Cancer Research, medicine.medical_specialty, Population, HIV Infections, Comorbidity, Rate ratio, Risk Assessment, Men who have sex with men, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Risk Factors, Cancer screening, Humans, Mass Screening, Medicine, Anal cancer, Cumulative incidence, 030212 general & internal medicine, Homosexuality, Male, education, Gynecology, Acquired Immunodeficiency Syndrome, education.field_of_study, business.industry, Incidence, Incidence (epidemiology), ORIGINAL REPORTS, Middle Aged, Anus Neoplasms, medicine.disease, United States, Oncology, 030220 oncology & carcinogenesis, Female, business, Demography
Abstract: Purpose People with HIV infection have an elevated risk of anal cancer. However, recent calendar trends are incompletely described, and which population subgroups might benefit from cancer screening is unknown. Methods We used linked data from HIV and cancer registries in nine US areas (1996 to 2012). We calculated standardized incidence ratios to compare anal cancer incidence in people with HIV infection with the general population, used Poisson regression to evaluate anal cancer incidence among subgroups of people with HIV and to assess temporal trends, and estimated the cumulative incidence of anal cancer to measure absolute risk. Results Among 447,953 people with HIV infection, anal cancer incidence was much higher than in the general population (standardized incidence ratio, 19.1; 95% CI, 18.1 to 20.0). Anal cancer incidence was highest among men who have sex with men (MSM), increased with age, and was higher in people with AIDS than in those without AIDS (ie, HIV only; adjusted incidence rate ratio, 3.82; 95% CI, 3.27 to 4.46). Incidence among people with HIV increased steeply during 1996 to 2000 (annual percentage change, 32.8%; 95% CI, −1.0% to 78.2%), reached a plateau during 2001 to 2008, and declined during 2008 to 2012 (annual percentage change, −7.2%; 95% CI, −14.4% to 0.6%). Cumulative incidence after a 5-year period was high for MSM with HIV only age 45 to 59 or ≥ 60 years (0.32% to 0.33%) and MSM with AIDS age 30 to 44, 45 to 59, or ≥ 60 years (0.29% to 0.65%). Conclusion Anal cancer incidence is markedly elevated among people with HIV infection, especially in MSM, older individuals, and people with AIDS. Recent declines may reflect delayed benefits of HIV treatment. Groups with high cumulative incidence of anal cancer may benefit from screening.
Published: 2018

31. Environmental Stressors Suffered by Women with Gynecological Cancers in the Aftermath of Hurricanes Irma and María in Puerto Rico

Author: Yanina M Bernhardt, Edna Acosta-Pérez, Sandra I García-Camacho, Andrea M Pacheco Díaz, Mirza Rivera-Lugo, William A. Calo, Pablo Méndez-Lázaro, Ana P. Ortiz-Martinez, and Naydi Pérez
Subjects: medicine.medical_specialty, extreme weather events, Genital Neoplasms, Female, Health, Toxicology and Mutagenesis, Context (language use), Health outcomes, Article, Disasters, Extreme weather, Environmental health, medicine, Humans, Cascading effects, environmental stressors, Cyclonic Storms, Public health, Puerto Rico, Stressor, Public Health, Environmental and Occupational Health, gynecological cancer, Focus group, Geography, Medicine, Female, cancer patients, Delivery of Health Care, Environmental Health, vulnerable populations, Qualitative research
Abstract: Background: Hurricanes are the immediate ways that people experience climate impacts in the Caribbean. These events affect socio-ecological systems and lead to major disruptions in the healthcare system, having effects on health outcomes. In September 2017, Puerto Rico (PR) and the United States Virgin Islands (USVI) experienced one of the most catastrophic hurricane seasons in recent history (Hurricane Irma was a Category 5 and Hurricane María was a Category 4 when they hit PR). Objective: This study examines environmental stressors experienced by women with gynecologic (GYN) cancers from PR and USVI who received oncologic cancer care in PR, in the aftermath of the hurricanes. Methods: A descriptive qualitative study design was used to obtain rich information for understanding the context, barriers, knowledge, perspectives, risks, vulnerabilities, and attitudes associated to these hurricanes. We performed focus groups among GYN cancer patients (n = 24) and key-informant interviews (n = 21) among health-care providers and administrators. Interviews were conducted from December 2018–April 2019. Results: Environmental health stressors such as lack of water, heat and uncomfortable temperatures, air pollution (air quality), noise pollution, mosquitos, and rats ranked in the top concerns among cancer patients and key-informants. Conclusions: These findings are relevant to cancer patients, decision-makers, and health providers facing extreme events and disasters in the Caribbean. Identifying environmental secondary stressors and the most relevant cascading effects is useful for decision-makers so that they may address and mitigate the effects of hurricanes on public health and cancer care.
Published: 2021

32. Prevalence and correlates of cervical HPV infection in a clinic-based sample of HIV-positive Hispanic women

Author: A. Scorsone, M. Soto-Salgado, P. Piovanetti, I. Febo, Y. Yamamura, H.L. Venegas-Ríos, V. Tamayo, Ana P. Ortiz, and Carmen D. Zorrilla
Subjects: Uterine Cervical Neoplasms, HIV Infections, Cervix Uteri, Cervix, Genital warts, 0302 clinical medicine, Cost of Illness, Risk Factors, Surveys and Questionnaires, Odds Ratio, Prevalence, 030212 general & internal medicine, Papillomaviridae, Cervical cancer, education.field_of_study, biology, Coinfection, Obstetrics, HPV infection, virus diseases, Hispanic or Latino, 3. Good health, Sexual Partners, Infectious Diseases, medicine.anatomical_structure, Condylomata Acuminata, 030220 oncology & carcinogenesis, Female, Adult, HPV, medicine.medical_specialty, Population, Article, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), Virology, medicine, Humans, lcsh:RC109-216, education, Gynecology, business.industry, Puerto Rico, Papillomavirus Infections, HIV, Hispanic women, biology.organism_classification, medicine.disease, Cross-Sectional Studies, Logistic Models, DNA, Viral, business
Abstract: Objectives: Puerto Rico (PR), is the fifth highest jurisdiction of the United States of America (US) with respect to HIV prevalence and the leading in cervical cancer incidence. This cross-sectional study describes the prevalence and correlates of cervical HPV infection among a clinic-based sample of 302 women living with HIV/AIDS in PR. Methods: Data collection included questionnaires, blood and cervical samples. Multivariable logistic regression models were used to estimate the magnitude of association (adjusted Prevalence odds ratio [aPOR]) between HPV cervical infection and other covariates. Results: Mean age of participants was 40.3 years (Â± 10.3Â SD). The prevalence of HPV infection was 50.3%; 41.1% for low-risk types and 29.5% for high-risk types. Having â¥ 10 lifetime sexual partners (aPOR = 2.10, 95% CI:1.02â4.29), an abnormal Pap (aPOR = 3.58, 95% CI:1.93â6.62), active genital warts (aPOR = 3.45, 95% CI:1.60â7.42), and CD4 counts â¤ 200 (aPOR = 4.24, 95% CI: 1.67â10.78) were positively associated with any cervical HPV infection. Similar results were observed for HR HPV infection. Conclusions: A high burden of HPV co-infection exists among women living with HIV/AIDS in this population. Given the high incidence of HIV in PR and the higher risk of cervical cancer among women living with HIV/AIDS, HPV vaccination should be promoted in this population. Keywords: HIV, HPV, Cervix, Hispanic women, Puerto Rico
Published: 2017

33. Characterization and Comparison of Physical and Mental Health Profiles and Department of Veterans Affairs Health Care Utilization Patterns among Operation Iraqi Freedom/Operation Enduring Freedom Women Veterans in Puerto Rico versus the United States

Author: Kristin M. Mattocks, Brad Cannell, Cynthia Brandt, Julie C. Weitlauf, Mabel E. Quiñones Vázquez, Aimee R. Kroll-Desrosiers, Ana P. Ortiz, and Mayra N. Berrios Hernandez
Subjects: Adult, Male, medicine.medical_specialty, Health (social science), Cross-sectional study, Health Status, Population, 01 natural sciences, Communicable Diseases, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Maternity and Midwifery, Health care, medicine, Humans, 030212 general & internal medicine, 0101 mathematics, education, Veterans Affairs, Iraq War, 2003-2011, Depression (differential diagnoses), Reproductive health, Veterans, education.field_of_study, Afghan Campaign 2001, business.industry, Mental Disorders, 010102 general mathematics, Puerto Rico, Public Health, Environmental and Occupational Health, Obstetrics and Gynecology, Odds ratio, Health Services, Middle Aged, Patient Acceptance of Health Care, Mental health, United States, United States Department of Veterans Affairs, Cross-Sectional Studies, Mental Health, Family medicine, Chronic Disease, Female, Reproductive Health Services, business
Abstract: Background Research on the physical and mental health profiles and patterns of health care use among women veterans receiving health care from the Department of Veterans Affairs (VA) on the island of Puerto Rico is lacking. Methods This cross-sectional study examines differences in physical and mental health conditions, and patterns of VA health care use, between women veterans of the Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) era who were using VA facilities in Puerto Rico (n = 897) and those using U.S.-based VA facilities (n = 117,216) from 2002 to 2015. Results Results of fully adjusted logistic regression models revealed that OIF/OEF women in Puerto Rico had heightened risk for global pain-related disorders (i.e., any pain) (adjusted odds ratio [AOR], 1.45; 95% confidence interval [CI], 1.22–1.71), back pain (AOR, 1.83; 95% CI, 1.56–2.14), diabetes (AOR, 1.42; 95% CI, 1.03–1.95), hyperlipidemia (AOR, 3.34; 95% CI, 2.80–3.98), major depression (AOR, 1.78; 95% CI, 1.53–2.06), and bipolar depression (AOR, 1.66; 95% CI, 1.34–2.04). They also evidenced greater risk for a host of reproductive health conditions and had higher average annual use of VA health care than their U.S. counterparts. Conclusions OIF/OEF women receiving VA health care in Puerto Rico evidenced a greater burden of physical illness, depression, and heightened use of VA health care services relative to their U.S. counterparts. Providers’ increased awareness of the physical and mental health care needs of this population is warranted. Research efforts that help to identify efficient and effective strategies to provide culturally tailored and/or personalized health care for this population could also be useful.
Published: 2019

34. Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis

Author: Marianne A B van der Sande, Timothy J. Wilkin, Lynette Menezes, Alessandra Pierangeli, Jiri Slama, Isabelle Heard, Beatriz Grinsztejn, Byron Romero, Adhemar Longatto-Filho, Ningshao Xia, Joel M. Palefsky, Ting Wu, Steve Simpson, Chunqing Lin, Sheela Godbole, K.W.M. D'Hauwers, Fernanda K. Tso, Yurii B. Shvetsov, Racheal S. Dube Mandishora, Borek Sehnal, Marc T. Goodman, Carmen Hidalgo-Tenorio, Silvia Franceschi, María del Refugio González Losa, Ana P. Ortiz, Lays Paula Bondi Volpini, Feixue Wei, Maarten F. Schim van der Loeff, Gary M. Clifford, Alexandra de Pokomandy, Erna Milunka Kojic, Lois Conley, Brenda Y. Hernandez, Ina U. Park, Annette H. Sohn, Nancy A. Hessol, Reshmie Ramautarsing, Paula N. Gonzalez, Anna-Barbara Moscicki, Katina Robison, Aimée R. Kreimer, Sandra A. Heráclio, Zizipho Z. A. Mbulawa, and Universidade do Minho
Subjects: medicine.medical_specialty, health care facilities, manpower, and services, education, Medicina Básica [Ciências Médicas], Uterine Cervical Neoplasms, Cochrane Library, Global Health, Anal lesions, Article, 03 medical and health sciences, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, HIV Seropositivity, medicine, Journal Article, Prevalence, Anal cancer, Humans, 030212 general & internal medicine, health care economics and organizations, Early Detection of Cancer, Intraepithelial neoplasia, Human papillomavirus 16, Science & Technology, business.industry, Obstetrics, Papillomavirus Infections, HPV infection, Cancer, virus diseases, Papillomavirus, Anal Cancer, Cervical infection, medicine.disease, Anus, Anus Neoplasms, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], medicine.anatomical_structure, Pooled analysis, Infectious Diseases, 030220 oncology & carcinogenesis, Ciências Médicas::Medicina Básica, Female, business
Abstract: Cervical cancer screening might contribute to the prevention of anal cancer in women. We aimed to investigate if routine cervical cancer screening results-namely high-risk human papillomavirus (HPV) infection and cytohistopathology-predict anal HPV16 infection, anal high-grade squamous intraepithelial lesions (HSIL) and, hence, anal cancer., International Agency for Research on Cancer
Published: 2018

35. Elimination of cervical cancer in U.S. Hispanic populations: Puerto Rico as a case study

Author: Marievelisse Soto-Salgado, Ana P. Ortiz, Maria E. Fernandez, Guillermo Tortolero-Luna, William A. Calo, Pamela C. Hull, and Vivian Colón-López
Subjects: Epidemiology, Population, Ethnic group, Uterine Cervical Neoplasms, 01 natural sciences, White People, World health, 03 medical and health sciences, 0302 clinical medicine, Cancer screening, Humans, Medicine, Hispanic population, 030212 general & internal medicine, 0101 mathematics, education, Early Detection of Cancer, Cervical cancer, education.field_of_study, business.industry, Puerto Rico, 010102 general mathematics, Public Health, Environmental and Occupational Health, Hpv vaccination, Hispanic or Latino, medicine.disease, United States, Increased risk, Female, business, Demography
Abstract: Cervical cancer remains a major burden for women around the world. In 2018, the World Health Organization called for the elimination of cervical cancer worldwide (
Published: 2021

36. Periodontitis and oral human papillomavirus infection among Hispanic adults

Author: Maira Alejandra Castaneda, Ana P. Ortiz, Kaumudi Joshipura, Elba C. Díaz, Cristina Muñoz, Hilmaris Centeno, José Vivaldi-Oliver, Daisy González, Joel M. Palefsky, Cynthia M. Pérez, and Vivian Rivera
Subjects: Male, Longitudinal study, Hispanics, Overweight, Logistic regression, Cervical Cancer, 0302 clinical medicine, Risk Factors, Odds Ratio, Longitudinal Studies, Cancer, Age Factors, virus diseases, Hispanic or Latino, Middle Aged, 3. Good health, Infectious Diseases, 030220 oncology & carcinogenesis, Female, Hispanic Americans, medicine.symptom, Infection, Adult, medicine.medical_specialty, Oral health, National Health and Nutrition Examination Survey, Severe periodontitis, Article, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Sex Factors, Clinical Research, Virology, Internal medicine, medicine, Humans, Adults, lcsh:RC109-216, Oral HPV, Dental/Oral and Craniofacial Disease, Periodontitis, Aged, business.industry, Prevention, Papillomavirus Infections, Puerto Rico, 030206 dentistry, Odds ratio, Periodontology, medicine.disease, Logistic Models, Cross-Sectional Studies, Good Health and Well Being, Sexually Transmitted Infections, business
Abstract: Introduction: Research on the association between periodontitis and oral human papilloma virus (HPV) infection is inconsistent. The cross-sectional association of severe periodontitis with oral HPV infection was investigated in a sample of Hispanic adults. Methods: Data from the 2014–2016 San Juan Overweight Adults Longitudinal Study (n = 740) was analyzed. Periodontitis assessment and self-collection of oral HPV samples followed the National Health and Nutrition Examination Survey methodology. Periodontitis was defined using the Centers of Disease Control and Prevention/American Academy of Periodontology definition. HPV typing was performed using polymerase chain reaction. Multivariate logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: 5.7% of participants had oral HPV infection and 20.3% had severe periodontitis. Adults with severe periodontitis had higher odds of oral HPV infection than those with none/mild disease (OR=2.9, 95% CI: 1.0–8.4, p
Published: 2018

37. Risk of oral tongue cancer among immunocompromised transplant recipients and human immunodeficiency virus-infected individuals in the United States

Author: Joseph E, Tota, Eric A, Engels, Margaret M, Madeleine, Christina A, Clarke, Charles F, Lynch, Ana P, Ortiz, Brenda Y, Hernandez, and Anil K, Chaturvedi
Subjects: Adult, Graft Rejection, Immunosuppression Therapy, Male, Squamous Cell Carcinoma of Head and Neck, Incidence, Lymphoma, Non-Hodgkin, HIV Infections, Pharyngeal Neoplasms, Organ Transplantation, Middle Aged, Transplant Recipients, United States, Tongue Neoplasms, Cohort Studies, Immunocompromised Host, Sexual and Gender Minorities, Risk Factors, Humans, Female, Registries, Papillomaviridae
Abstract: Oral tongue cancer incidence has increased among whites in the United States; however, the cause remains unknown. If an infectious agent is implicated, then elevated risk would be expected among immunosuppressed individuals.By using population-based registry linkage information from the US Transplant Cancer Match and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) Cancer Match studies, the authors examined the risk of oral tongue squamous cell carcinoma (SCC) among immunocompromised transplantation recipients and HIV-infected individuals. In addition, the risks of oropharyngeal SCC (strongly related to human papillomavirus infection; modestly affected by immunosuppression), other tobacco/alcohol-related oral cavity SCCs (not thought to be infection/immunosuppression-related), and non-Hodgkin lymphoma of oral cavity/pharynx (strongly related to Epstein-Barr virus; profoundly affected by immunosuppression) were evaluated.Compared with the general population, the risk of non-Hodgkin lymphoma was strongly increased (standardized incidence ratio [SIR] 8.0). The risk of all SCCs was modestly and similarly elevated among transplantation recipients (SIR range, 2.2-2.7; PSimilar modest increases in the risk of oral tongue and other oral cavity SCCs do not suggest that an infectious agent or exposure profoundly affected by immunosuppression underlies the increase in oral tongue cancer. Cancer 2018;124:2515-22. © 2018 American Cancer Society.
Published: 2017

38. Factors Associated with HPV Vaccine Awareness in a Population-Based Sample of Hispanic Women in Puerto Rico

Author: Daniela Caballero-Varona, Joel M. Palefsky, Cynthia M. Pérez, Edmir Marrero, Guillermo Tortolero-Luna, Ana P. Ortiz, Erick Suárez, Cristina Muñoz, and Josefina Romaguera
Subjects: Gerontology, and promotion of well-being, Health Knowledge, Attitudes, Practice, Health (social science), Sociology and Political Science, Hispanics, Cervical Cancer, Logistic regression, 0302 clinical medicine, Epidemiology, 030212 general & internal medicine, Puerto Ricans, Cancer, Practice, education.field_of_study, Health Knowledge, Health Policy, virus diseases, Population based sample, Middle Aged, Health awareness, Health equity, Vaccination, Infectious Diseases, 3.4 Vaccines, Sexual behavior, 030220 oncology & carcinogenesis, Public Health and Health Services, HIV/AIDS, Female, Infection, Adult, Human papillomavirus, medicine.medical_specialty, Adolescent, Population, Article, Vaccine Related, Young Adult, 03 medical and health sciences, Clinical Research, medicine, Humans, Papillomavirus Vaccines, education, HPV vaccine, Descriptive statistics, business.industry, Prevention, Papillomavirus Infections, Puerto Rico, Public Health, Environmental and Occupational Health, Prevention of disease and conditions, Good Health and Well Being, Cross-Sectional Studies, Attitudes, Anthropology, Sexually Transmitted Infections, Immunization, Health disparities, HPV and/or Cervical Cancer Vaccines, business, Demography
Abstract: ObjectivesThe objective of this study was to investigate the factors associated with HPV awareness among women aged 16 to 64years, among underserved minority Hispanic women living in Puerto Rico.MethodsA population-based, cross-sectional sample of 566 women, ages 16 to 64years, living in the San Juan metropolitan area were surveyed regarding sexual behavior, HPV knowledge, and HPV vaccine uptake. Data was analyzed using descriptive statistics and multivariate logistic regression.ResultsOverall, 64.8% of the women in the sample had heard about the HPV vaccine. Among those in the recommended catch-up vaccination age range (16-26years, n = 86), 4.7% had received at least one dose of the HPV vaccine. Of those aware of the availability of the HPV vaccine, most had learned about it through the media, whereas, only 39.6% had learned about it from a physician. Multivariate logistic regression analysis showed that HPV awareness (OR 8.6; 95% CI 5.0-14.8) and having had an abnormal Pap smear (OR 2.0; 95% CI 1.2-3.4) were associated with HPV vaccine awareness (p
Published: 2015

39. Cervical Cancer Screening and Sexual Risky Behaviors among a Population of Hispanic Origin

Author: Erick Suárez, Daisy González, and Ana P. Ortiz
Subjects: Adult, Gerontology, Health (social science), Adolescent, Cross-sectional study, Sexual Behavior, Population, Uterine Cervical Neoplasms, Young Adult, Risk-Taking, Risk Factors, Maternity and Midwifery, Odds Ratio, Prevalence, medicine, Humans, Pap test, Young adult, education, Early Detection of Cancer, Vaginal Smears, education.field_of_study, Cervical screening, medicine.diagnostic_test, business.industry, Puerto Rico, Public Health, Environmental and Occupational Health, HPV infection, Obstetrics and Gynecology, Secondary data, Hispanic or Latino, Odds ratio, Middle Aged, medicine.disease, Cross-Sectional Studies, Socioeconomic Factors, Female, Self Report, business, Papanicolaou Test, Demography
Abstract: To assess the prevalence of cervical cancer screening through Papanicolaou (Pap) test utilization and its association with sexual behaviors among a population-based sample of Hispanic women in Puerto Rico (PR).This study was a secondary data analysis of the database of a cross-sectional study of HPV infection in PR (2010-2013; n = 554 women). Pap test utilization (past 3 years) was self-reported and sexual risky behavior was defined as an index that considered the following sexual behaviors: early age of sexual debut (≤16 years), 11 or more lifetime sexual partners, and 2 or more sexual partners in the last year. Multivariable logistic regression was used to estimate the magnitude of the association between sexual risk behavior and Pap test utilization, after adjusting for socioeconomic and lifestyles characteristics.The overall prevalence of Pap test utilization was 78.0%. Pap test screening varied with sexual behavior, with women with none or one risky sexual behavior having higher odds of Pap test utilization in the past 3 years (odds ratio [OR], 1.74; 95% CI, 1.03-2.93) compared with those with two or three risky sexual behaviors. This difference remained marginally significant (p.10) after adjusting for age, educational attainment, smoking status and STI history (OR, 1.72; 95% CI, 0.96-3.08).The prevalence of cervical cancer screening in this population (78%) is still below Healthy People 2020 recommendations (93%). Also, women with risky sexual behaviors are less likely to have been screened. Efforts to promote cervical screening programs should focus on these high-risk women as a method for cervical cancer prevention and control.
Published: 2015

40. Human Papilloma Virus Awareness Among Hispanic Females with Inflammatory Bowel Disease

Author: Maysabel Aponte, Ana P. Ortiz, Esther A. Torres, Jose E. Rivera-Acosta, Irene Villamil, and Josefina Romaguera
Subjects: Adult, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Health (social science), Sociology and Political Science, Cross-sectional study, Population, Uterine Cervical Neoplasms, Human papilloma virus, HPV vaccines, Article, Inflammatory bowel disease, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Epidemiology, medicine, Humans, Papillomavirus Vaccines, 030212 general & internal medicine, education, HPV vaccine, Cervical cancer, education.field_of_study, business.industry, Health Policy, Papillomavirus Infections, Puerto Rico, Public Health, Environmental and Occupational Health, HPV infection, virus diseases, Hispanic or Latino, Inflammatory Bowel Diseases, medicine.disease, 3. Good health, Vaccination, Exact test, Cross-Sectional Studies, Anthropology, Immunology, Female, 030211 gastroenterology & hepatology, business
Abstract: Women with inflammatory bowel disease (IBD) may be at increased risk of human papilloma virus (HPV) infection and HPV-related malignancies, as many are immunocompromised secondary to the use of immunosuppressant agents. Several studies have addressed the knowledge about cervical cancer risk factors in different populations, particularly HPV infection and its association with cervical malignancies; most of these studies show poor patient knowledge. The purpose of this study is to describe the knowledge of females with IBD about HPV infection and the HPV vaccine. We performed a cross-sectional study in 147 consecutive patients attending the clinics of the University of Puerto Rico Center for IBD from 2009 to 2010. An interviewer-administered questionnaire was used to collect information on demographics, lifestyles, and HPV-related knowledge of participants. Bivariate analysis using the chi-square statistics and Fisher’s exact test was used to examine factors associated with HPV awareness. The mean age of participants was 36.6 years (SD = 13.91 years). Three fourth (77 %) of women had awareness of the existence of HPV, and 58 % did know about the existence of HPV vaccines. Among those who had heard about HPV, 79.6 % knew that HPV can cause cervical cancer, and 57.5 % knew that the virus is sexually transmitted. Among those who knew of the vaccine, 75.3 % learned about its existence through the media, while only 15.3 %, through their health-care provider. Only three women within recommended ages (2 %) had been vaccinated against HPV, although 50 % of participants indicated that they would definitely/probably vaccinate against HPV in the future. A significant trend was observed, where more educated women were more likely to have heard of HPV (p for trend = 0.0017). Women who were high school graduates/some college (OR = 6.63, 95 % CI = 1.71–25.66) and those with at least an associate degree (OR = 11.69, 95 % CI = 3.05–45.89) were more likely to be aware of the HPV vaccine than women without a high school degree. Our study documents poor knowledge of HPV and HPV vaccine in this population of IBD patients in Puerto Rico. Although vaccination coverage is low in this population, women are receptive to the possibility of vaccination in the future. Given that this population may be at an increased risk of HPV infection and related morbidities, education and vaccination programs should be promoted among them.
Published: 2015

41. Assessing Lung Cancer Incidence Disparities Between Puerto Ricans and Other Racial/Ethnic Groups in the United States, 1992–2010

Author: Ana P. Ortiz, Marievelisse Soto-Salgado, Rafael A. Quintana, Erick Suárez, and William A. Calo
Subjects: Adult, Male, Change over time, Gerontology, medicine.medical_specialty, Lung Neoplasms, Epidemiology, Ethnic group, Article, Young Adult, medicine, Humans, Sex Distribution, Young adult, Lung cancer, Aged, Aged, 80 and over, business.industry, Incidence, Public health, Incidence (epidemiology), Puerto Rico, Racial Groups, Public Health, Environmental and Occupational Health, Middle Aged, medicine.disease, United States, Racial ethnic, Female, Standardized rate, business, Demography
Abstract: This study compared the incidence of lung cancer among Puerto Ricans (PRs) with that of Whites, Blacks, and Hispanics in the United States. We computed age-standardized rates of lung cancer during 1992–2010 and percentages of change over time. Standardized rate ratios (SRR) were estimated to assess racial/ethnic and gender differences. All men groups showed a significant decline in lung cancer over time but PRs observed the smallest change (−1.2 %). For both men and women, PRs had lower incidence rates compared to other racial/ethnic groups (SRR < 1; P < 0.05). Among all groups, men reported higher incidence rates than women but PRs showed the largest gender disparity (SRR = 2.29). This study showed that although PRs exhibited lower incidence rates of lung cancer, this subgroup of Hispanics faced an important burden of lung cancer, principally because PR men had the smallest decline over time and the largest gender difference among all groups.
Published: 2015

42. Population-Based Study of Tobacco Use Among People Living With HIV in Puerto Rico

Author: Eileen Charneco, Daisy González-Barrios, Sandra Miranda De León, Vivian Colón-López, Leticia Román, Mark Machin, Ana P. Ortiz, Orquidea Frias-Belén, and Gladys Girona-Lozada
Subjects: Adult, Male, Health (social science), Tobacco use, Adolescent, medicine.medical_treatment, Population, Human immunodeficiency virus (HIV), Medicine (miscellaneous), HIV Infections, Disease, Logistic regression, medicine.disease_cause, 03 medical and health sciences, Tobacco Use, Young Adult, 0302 clinical medicine, Sex Factors, Sampling design, Prevalence, Medicine, Humans, 030212 general & internal medicine, education, education.field_of_study, 030505 public health, business.industry, Puerto Rico, Public Health, Environmental and Occupational Health, Middle Aged, Population based study, Psychiatry and Mental health, Cross-Sectional Studies, Smoking cessation, Female, 0305 other medical science, business, Demography
Abstract: Background Despite substantial advances in the era of highly active antiretroviral therapy, HIV-positive persons are at high risk of tobacco-related disease and mortality. This study describes the prevalence and sociodemographic factors associated with current tobacco use among HIV-positive men and women 18 years and older receiving HIV care in Puerto Rico. Methods Data from the 2009 Medical Monitoring Project (MMP) was used. A three-stage sampling design was conducted to obtain annual cross-sectional probability samples of HIV-infected adults in care. Factors associated with current tobacco use were identified using logistic regression models. All analyses were performed using STATA version 11.0. Results The estimated prevalence of current cigarette use among the population was 29.0% (95%CI: 23.5%-35.2%), daily smoking was reported in 76.7% of them. Multivariate logistic regression models, showed that male drug users (injected and noninjected) were up to nine times more likely to be current smokers (OR = 9.9; 95%CI = 3.1, 31.5) as compared to nonusers. Conclusion Findings highlight the need for smoking cessation strategies in this population, particularly among male HIV+ drug users.
Published: 2017

43. The Association Between Fruit and Vegetable Intake, Knowledge of the Recommendations, and Health Information Seeking Within Adults in the U.S. Mainland and in Puerto Rico

Author: Lila J. Finney Rutten, Vivian Colón-López, Uriyoán Colón-Ramos, Ana P. Ortiz, Richard P. Moser, and Amy L. Yaroch
Subjects: Adult, Male, Gerontology, Health Knowledge, Attitudes, Practice, Health (social science), Multivariate analysis, Adolescent, Health information seeking, Information Seeking Behavior, Puerto rican, Library and Information Sciences, Recommended Dietary Allowances, White People, Young Adult, Environmental health, Information seeking behavior, Vegetables, Humans, Medicine, Aged, Consumer Health Information, business.industry, Communication, Puerto Rico, Public Health, Environmental and Occupational Health, Hispanic or Latino, Middle Aged, Health Surveys, United States, Diet, Health Information National Trends Survey, Black or African American, Socioeconomic Factors, Fruit, Fruits and vegetables, Female, Mainland, Health information, business
Abstract: Health information correlates of fruit and vegetable intake and of knowledge of the fruit and vegetable recommendations were examined using bivariate and multivariate regressions with data from the 2007-2008 U.S. National Cancer Institute's Health Information National Trends Survey in the United States and in Puerto Rico. Residents from Puerto Rico had the lowest reported fruit and vegetable intake and the lowest knowledge of the recommended servings of fruits and vegetables to maintain good health, compared with U.S. Hispanics, non-Hispanic Whites, and Blacks. Sixty-seven percent of Puerto Rican residents and 62% of U.S. Hispanics reported never seeking information on health or medical topics. In multivariate analysis, those who never sought information on health or medical topics reported significantly lower fruit and vegetable intake (coefficient = -0.24; 95% CI [-0.38, -0.09]), and were less likely to know the fruit and vegetable recommendations (OR = 0.32; 95% CI [0.20, 0.52]), compared with those who obtained information from their health care providers. Health promotion initiatives in the United States and Puerto Rico have invested in mass media campaigns to increase consumption of and knowledge about fruit and vegetables, but populations with the lowest intake are less likely to seek information. Strategies must be multipronged to address institutional, economic, and behavioral constraints of populations who do not seek out health information from any sources.
Published: 2014

44. High Prevalence of Diabetes and Prediabetes and Their Coexistence with Cardiovascular Risk Factors in a Hispanic Community

Author: Erick Suárez, Ana P. Ortiz, Marievelisse Soto-Salgado, Manuel Guzmán, and Cynthia M. Pérez
Subjects: Adult, Blood Glucose, Male, Gerontology, medicine.medical_specialty, Epidemiology, Disease, Article, Prediabetic State, Young Adult, symbols.namesake, Risk Factors, Internal medicine, Diabetes mellitus, Diabetes Mellitus, Prevalence, medicine, Humans, Prediabetes, Poisson regression, Young adult, Risk factor, Abdominal obesity, Aged, business.industry, Puerto Rico, Public Health, Environmental and Occupational Health, nutritional and metabolic diseases, Hispanic or Latino, Middle Aged, medicine.disease, Cardiovascular Diseases, symbols, Female, medicine.symptom, business, Blood drawing
Abstract: This study examined the prevalence and association of diabetes mellitus (DM) and prediabetes with cardiovascular risk factors among Puerto Ricans adults. Data from a household survey of 857 adults aged 21–79 years who underwent interviews, physical exams, and blood draws were analyzed. Prevalence of total DM and prediabetes was estimated using American Diabetes Association diagnostic criteria of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c). Poisson regression models were used to estimate the prevalence ratio for each cardiovascular risk factor under study. Age-standardized prevalence of total DM and prediabetes, detected by FPG and/or HbA1c, was 25.5 and 47.4 %, respectively. Compared with participants with normoglycemia, those with previously diagnosed DM, undiagnosed DM, and prediabetes had more adverse cardiovascular risk factor profiles, characterized by a higher prevalence of general and abdominal obesity, hypertension, low HDL cholesterol, elevated LDL cholesterol, elevated triglycerides, and elevated plasminogen activator inhibitor 1 (p < 0.05). The high prevalence of DM and prediabetes calls for public health actions to plan and implement lifestyle interventions to prevent or delay the onset of DM and cardiovascular disease.
Published: 2014

45. Survival from Anal Cancer Among Hispanics—Puerto Rico, 2000–2007

Author: Vivian Colón-López, Erick Suárez, Juan José Mercado-Acosta, Naydi Pérez, Marievelisse Soto-Salgado, Ana P. Ortiz, Humberto M. Guiot, and Mariela Torres-Cintrón
Subjects: Male, medicine.medical_specialty, Time Factors, Population, Adenocarcinoma, Men who have sex with men, Risk Factors, Epidemiology, medicine, Humans, Anal cancer, education, Aged, Neoplasm Staging, Gynecology, education.field_of_study, Relative survival, business.industry, Incidence, Incidence (epidemiology), Puerto Rico, Gastroenterology, Cancer, Hispanic or Latino, Anal canal, Anus Neoplasms, Prognosis, medicine.disease, Survival Rate, medicine.anatomical_structure, Oncology, Carcinoma, Squamous Cell, Female, business, Follow-Up Studies, Demography
Abstract: The incidence of anal cancer is increasing, particularly among HIV and men who have sex with men (MSM) groups. The vast majority of cases are associated with human papillomavirus (HPV), the most common sexually transmitted infection. Epidemiological studies have also documented low survival, which might be linked to lack of appropriate screening, access, and utilization of pertinent health care services. Our objective was to assess the relative survival (1 and 3 years) of anal cancer in Puerto Rico for men and women during the period from 2000–2007. All histological types of cancer of anus, anal canal, and anorectum (ICD-O-3 codes C210-C218), except for sarcomas, were included. Relative survival was estimated with the use of life tables from the population of Puerto Rico. In addition, the excess survival was compared by age at diagnosis, histology, and stage (defined as local, regional, or distant), using the Poisson regression model. The overall 3-year relative survival in Puerto Rico was the same (53 %) for men and women. Our findings establish baseline survival data for anal cancer in Hispanics from Puerto Rico. Since now, the national guidelines for anal cancer screening and treatment are on their way to be determined; baseline information about survival will allow monitoring the efficacy that standardized screening programs may eventually have in increasing anal cancer survival in this population.
Published: 2014

46. Association Between the Hypertriglyceridemic Waist Phenotype, Prediabetes, and Diabetes Mellitus Among Adults in Puerto Rico

Author: Manuel Guzmán Serrano, Cynthia M. Pérez Cardona, Erick L. Suárez Pérez, Ana P. Ortiz Martínez, and Mary Vanellys Diaz-Santana
Subjects: Adult, Blood Glucose, Male, medicine.medical_specialty, Waist, Epidemiology, Cross-sectional study, Health Behavior, Blood Pressure, 030209 endocrinology & metabolism, Article, Prediabetic State, Young Adult, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Risk Factors, Internal medicine, Diabetes mellitus, Diabetes Mellitus, medicine, Humans, Body Weights and Measures, 030212 general & internal medicine, Prediabetes, Young adult, Life Style, Aged, business.industry, Puerto Rico, Age Factors, Public Health, Environmental and Occupational Health, Hispanic or Latino, Middle Aged, Anthropometry, medicine.disease, Phenotype, Hypertriglyceridemic Waist, Cross-Sectional Studies, Blood pressure, Endocrinology, Socioeconomic Factors, Female, business
Abstract: This study assessed the association of the hypertriglyceridemic waist (HTGW) phenotype with prediabetes and diabetes (DM) in a group of Hispanics. Analysis of a cross-sectional study of 858 adults residing in Puerto Rico that collected data on blood pressure, biochemical, and anthropometric measurements was performed. HTGW phenotype was defined as elevated triglycerides and elevated waist circumference. Prediabetes was defined as a fasting glucose of 100-125 mg/dL and DM as a fasting glucose ≥126 mg/dL or prior diagnosis. Prevalence of HTGW, prediabetes, and DM was 27.9, 38.0, and 21.6 %, respectively. Subjects with the HTGW phenotype had higher adjusted odds of prediabetes (POR 5.55; 95 % CI 3.38-9.13) and DM (POR 7.28; 95 % CI 3.63-14.63) compared to those without the phenotype. The association for prediabetes was stronger for women than among men. HTGW phenotype was strongly associated with prediabetes and DM, reinforcing the need to further assess its performance as a screening tool to identify at-risk individuals for cardiometabolic conditions.
Published: 2014

47. Factors Associated with Perceived Patient-Provider Communication Quality among Puerto Ricans

Author: Sarah Krasny, Ana P. Ortiz, Guillemo Tortolero-Luna, Vivian Colón-López, and William A. Calo
Subjects: Adult, Male, Gerontology, Adolescent, Health Status, MEDLINE, Psychological intervention, Trust, Article, Health Services Accessibility, Interviews as Topic, Young Adult, Cronbach's alpha, Bayesian multivariate linear regression, Health care, Humans, Medicine, Young adult, Aged, Physician-Patient Relations, Depression, business.industry, Communication, Public Health, Environmental and Occupational Health, Hispanic or Latino, Middle Aged, Health Information National Trends Survey, Linear Models, Female, business, Communication quality
Abstract: Patient-provider communication is an important factor influencing patients' health outcomes. This study examined the relationship between patient-provider communication quality and sociodemographic, health care access, trusted information sources, and health status variables. Data were from a representative sample of 450 Puerto Rican adults who participated in the Health Information National Trends Survey. A composite score rating perceived patient-provider communication quality was created from five items (Cronbach's alpha = 0.87). A multivariate linear regression analysis was conducted. Patient-provider communication ratings were lower among the unemployed (p = 0.049), those who do not trust a lot in the information provided by their providers (p = 0.003), and respondents with higher depressive symptoms scores (p = 0.036). Perceived patient-provider communication quality, however, was higher among respondents who visited their providers five or more times in the last year (p = 0.023). Understanding patient perceptions of provider communication may serve to develop system-level interventions aimed at eliminating communication disparities and improving patients' health outcomes.
Published: 2014

48. Prevalence, genotyping, and correlates of anogenital HPV infection in a population-based sample of women in Puerto Rico

Author: Josefina Romaguera, Joel M. Palefsky, Edmir Marrero, Guillermo Tortolero-Luna, Ana P. Ortiz, Cristina Muñoz, Cynthia M. Pérez, Lorena González, Daisy González, and Erick Suárez
Subjects: Genotyping Techniques, Hispanics, Cervical Cancer, Reproductive Tract Infections, Anogenital HPV infection, 0302 clinical medicine, Prevalence, 030212 general & internal medicine, Young adult, Papillomaviridae, Cancer, education.field_of_study, biology, HPV infection, Anal Infection, Middle Aged, Vaccination, medicine.anatomical_structure, Infectious Diseases, 030220 oncology & carcinogenesis, Female, Infection, Adult, medicine.medical_specialty, Genotype, Adolescent, Population, Article, lcsh:Infectious and parasitic diseases, Interviews as Topic, Vaccine Related, 03 medical and health sciences, Young Adult, Virology, medicine, Humans, lcsh:RC109-216, Women, education, Cervix, Gynecology, Anus Diseases, business.industry, Prevention, Papillomavirus Infections, Puerto Rico, medicine.disease, Anus, biology.organism_classification, Sexually Transmitted Infections, Immunization, business, HPV and/or Cervical Cancer Vaccines
Abstract: Background: Oncogenic HPV infection is associated to anogenital cancer. We estimate the prevalence and correlates of anogenital HPV infection among a population-based sample of women aged 16–64 years living in the metropolitan area of Puerto Rico. Methods: 564 women completed face-to-face and computer assisted interviews and self-collected anal and cervical specimens. HPV DNA testing used MY09/MY11 consensus HPV L1 primers and beta-globin as an internal control for sample amplification. Positive specimens were typed by dot-blot hybridization. Results: Weighted prevalence of cervical, anal, and cervical/anal co-infection was 29.4%, 38.6%, and 17.1%, respectively. The commonest oncogenic HPV types detected in the cervix and anus were: 68 (8% vs. 7%) and 16 (5.5% vs. 5.1%), correspondingly. Having ≥3 lifetime sexual partners (OR: 2.3; 95% CI: 1.5–3.5) and last year anal intercourse (OR: 1.6; 95% CI: 1.1–2.5) increased the odds of anogenital HPV infection. Cervical infection was independently associated to anal infection (OR: 3.0; 95% CI: 2.0–4.6). Conclusions: Similar to others, our results confirm the burden of anogenital HPV infection in women and its relationship with sexual behavior. As vaccination increases, future studies should monitor changing trends in HPV infection in this population, and the relationship between anal and cervical HPV-related disease. Keywords: Anogenital HPV infection, Women, Hispanics, Puerto Rico
Published: 2016

49. Urine-based human papillomavirus DNA testing as a screening tool for cervical cancer in high-risk women

Author: Elizabeth R. Unger, Ana P. Ortiz, Keimari Mendez, Martin Steinau, Mariel Lopez, and Josefina Romaguera
Subjects: Adult, Oncology, medicine.medical_specialty, food.ingredient, Genotyping Techniques, Biopsy, Uterine Cervical Neoplasms, Cervix Uteri, Urine, Alphapapillomavirus, Sensitivity and Specificity, Article, Young Adult, food, Internal medicine, Cancer screening, Human papillomavirus DNA, Humans, Medicine, Screening tool, DNA Probes, HPV, Young adult, Human papillomavirus, Early Detection of Cancer, Cervical cancer, business.industry, virus diseases, Obstetrics and Gynecology, General Medicine, Middle Aged, medicine.disease, DNA, Viral, Female, business
Abstract: To test the hypothesis that self-collected urine could be used to detect high-risk human papillomavirus (HPV) DNA with sensitivity and specificity comparable to those of standard cervical testing.Women attending a gynecology clinic for evaluation of abnormal cytology were recruited. Fifty-two participants (21-60years of age) collected urine samples, and clinicians collected cervical brush samples. When appropriate, cervical biopsies were obtained during colposcopy. HPV detection and typing were performed on DNA extracts from each sample, using commercial reagents for L1 consensus polymerase chain reaction (PCR) and type-specific hybridization. HPV 16 viral load was determined by quantitative PCR in HPV 16-positive samples. A diagnostic test analysis was conducted for urine samples.Fifty paired samples were analyzed, with 76% agreement between samples. The 12 discrepant pairs were all urine negative/cervix positive. The most common HPV types detected were 16, 51, 53, and 62. The urine test correctly identified 100% of the uninfected and 65% of the infected patients.The results indicate that HPV DNA detection using urine is less sensitive than cervical sampling in a population with abnormal cytology. Further exploration is warranted to determine clinical utility when other options are unavailable.
Published: 2013

50. Prevalence of Overweight and Obesity and Their Cardiometabolic Comorbidities in Hispanic Adults Living in Puerto Rico

Author: Hesmy Sánchez, Ana P. Ortiz, and Cynthia M. Pérez
Subjects: Adult, Male, Gerontology, Health (social science), Cross-sectional study, Population, Comorbidity, Overweight, Article, Young Adult, Confidence Intervals, medicine, Humans, Obesity, Prediabetes, Sex Distribution, education, Aged, Metabolic Syndrome, education.field_of_study, business.industry, Puerto Rico, Public Health, Environmental and Occupational Health, Middle Aged, medicine.disease, Cross-Sectional Studies, Female, medicine.symptom, business, Body mass index, Dyslipidemia, Demography
Abstract: This study characterized the prevalence of overweight and obesity and assessed their cardiometabolic comorbidities in the population aged 21–79 years living in the San Juan Metropolitan Area of Puerto Rico. We analyzed data from a household survey conducted in Puerto Rico between 2005 and 2007 that used a representative sample of 840 non-institutionalized adults living in the San Juan Metropolitan Area. Body mass index categories were classified as normal weight, overweight and obese. Poisson regression model with robust variance was used to estimate the prevalence ratio to assess the association of each cardiometabolic comorbidity (hypertension, dyslipidemia, diabetes, prediabetes, systemic inflammation, prothrombotic state, and coronary heart disease) with overweight and obesity. Age-standardized prevalence of overweight and obesity was 35.9% and 41.5%, respectively, figures higher than the combined prevalence for the U.S. adult population (68.8%) but similar to all mainland Hispanics (78.8%). Men were more likely to be overweight than women (40.4% versus 33.4%), whereas more women than men were obese (43.7% versus 37.6%). Prevalence of all cardiometabolic comorbidities was significantly (p
Published: 2013

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